Emergency first aid for acute poisoning. General principles of providing primary care in acute poisoning In case of acute poisoning, it is necessary

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

Poisoning should be suspected in cases where a completely healthy person suddenly feels unwell immediately or a short time after eating or drinking, taking medication, as well as cleaning clothes, dishes and plumbing with various chemicals, treating the room with substances that kill insects or rodents, etc. P. Suddenly, general weakness may appear, even to the point of loss of consciousness, vomiting, convulsions, shortness of breath, and the skin of the face may suddenly turn pale or blue. The suspicion of poisoning is strengthened if one of the described symptoms or a combination of them appears in a group of people after eating or working together.

Causes of poisoning may be: medicines, food products, household chemicals, poisons of plants and animals. A toxic substance can enter the body in various ways: through the gastrointestinal tract, respiratory tract, skin, conjunctiva, or when the poison is injected (subcutaneously, intramuscularly, intravenously). The damage caused by the poison can be limited only to the place of first direct contact with the body (local effect), which is very rare. Most often, the poison is absorbed and has a general effect on the body (resorptive), manifested by primary damage to individual organs and systems of the body.

General principles of first aid for poisoning

1. Call an ambulance.

2. Resuscitation measures.

3. Measures to remove unabsorbed poison from the body.

4. Methods for accelerating the elimination of already absorbed poison.

5. Use of specific antidotes (antidotes).

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

2. Resuscitation measures are necessary in case of cardiac and respiratory arrest. They begin only if there is no pulse in the carotid artery, and after removing vomit from the oral cavity. These measures include artificial ventilation (ALV) and chest compressions. But this is not possible for all poisonings. There are poisons that are released with exhaled air (FOS, chlorinated hydrocarbons) from the respiratory tract of the victim, so those performing resuscitation can be poisoned by them.

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

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

If poison gets on the conjunctiva, it is best to rinse the eye with clean water or milk so that the rinsing water from the affected eye does not enter the healthy eye.

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

b) When poison enters through the mouth it is necessary to urgently call an ambulance, and only if this is impossible, or if it is delayed, only then can we proceed gastric lavage with water without using a tube. The victim is given several glasses of warm water to drink and then vomiting is induced by irritating the root of the tongue and pharynx with a finger or spoon. The total volume of water should be large enough, at home - at least 3 liters, when washing the stomach with a tube, use at least 10 liters.

It is better to use only clean warm water to rinse the stomach.

Probeless 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 waters repeatedly comes into contact with the affected areas of the mucous membrane of the oral cavity and esophagus, and this leads to more severe burns of these organs. It is especially dangerous to perform gastric lavage without a tube in young 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, since these substances can cause additional burns of the pharynx; 3) rinse the stomach with an alkali solution (baking soda) in case of acid poisoning. This is due to the fact that the interaction of acids and alkalis releases gas, which, accumulating in the stomach, can cause perforation of the stomach wall or painful shock.

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

A very good effect is obtained by introducing activated carbon 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 prepare a coal suspension 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 remains in the stomach or intestines for a long time, a toxic substance can be released from the microscopic pores of activated carbon and begin to be absorbed into the blood. Therefore, after taking activated carbon, it is necessary to administer a laxative. Sometimes, when providing first aid, activated carbon is given before gastric lavage, and then after this procedure.

Despite gastric lavage, some of the poison may 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 liquid for colon lavage is clean water.

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

5. Antidotes are used by emergency medical personnel or the toxicology department of a hospital only after determining the poison that poisoned the victim

Children get poisoned mostly at home; all adults should remember this!

First aid for drug poisoning.

Drug poisoning is especially dangerous to human life when it is caused sleeping pills or sedatives means. Drug poisoning is characterized by two phases.

Symptoms: in the first phase - excitement, loss of orientation, incoherent speech, chaotic movement, pale skin, rapid pulse, noisy, rapid breathing. In the second phase, sleep occurs, which can turn into an unconscious state.

Urgent Care: Before the doctor arrives, rinse the stomach and give strong tea or coffee, 100g of black crackers to drink, do not leave the patient alone, immediately call an ambulance.

Barbiturates

After 30-60 minutes. after taking toxic doses of barbiturates, symptoms similar to those observed during alcohol intoxication are observed. Nystagmus and constriction of the pupils may be observed. Gradually, deep sleep or (in severe poisoning) loss of consciousness occurs. The depth of the coma depends on the concentration of the drug in the blood. In a deep coma - breathing is rare, shallow, the pulse is weak, cyanosis, a symptom of “play of the pupils” (alternating dilation and constriction of the pupils).

Urgent Care. If the patient is conscious, it is necessary to induce vomiting or rinse the stomach through a tube with salted water, introduce activated charcoal and a saline diuretic. In case of coma - gastric lavage after preliminary intubation. Repeated rinsing is indicated every 3-4 hours until consciousness is restored.

Neuroleptics

Shortly after taking toxic doses of chlorpromazine, general weakness, dizziness, drowsiness, nausea, vomiting, and dry mouth are observed. In case of moderate poisoning, after a while, shallow sleep occurs, lasting a day or more. The skin is pale and dry. Body temperature is reduced. Coordination is impaired. Tremor and hyperkinesis are possible.

In severe poisoning, coma develops.

Reflexes are reduced or disappear. Paroxysms of general convulsions and respiratory depression may develop. Cardiac activity is weakened, the pulse is frequent, weak filling and tension, arrhythmias are possible. Blood pressure is reduced (up to the development of shock), the skin is pale, cyanosis. Death occurs from depression of the respiratory center and cardiovascular failure.

Urgent Care. Gastric lavage with water with the addition of table salt or isotonic sodium chloride solution. Saline laxative and activated charcoal. Oxygen therapy. In case of respiratory depression - IV L; in case of collapse - intravenous administration of fluids and norepinephrine. For arrhythmia - lidocaine and diphenine. For convulsions - diazepam, 2 ml of 0.5% solution.

Tranquilizers

20 minutes - 1 hour after taking the drug, general weakness, dizziness, unsteadiness of gait, impaired coordination (staggering when sitting, walking, moving limbs) and speech (chanting) occur. Psychomotor agitation may develop. Sleep soon sets in, lasting 10-13 hours. In severe poisoning, a deep coma with muscle atony, areflexia, respiratory depression and cardiac activity may develop, which can lead to death.

Urgent Care. Repeated gastric lavage every 3-4 hours during the first day. Saline laxative and activated charcoal. In case of respiratory depression - mechanical ventilation.

Drug poisoning can be when taken orally, as well as when administering narcotic drugs by injection. Narcotic drugs are quickly absorbed in the stomach. Lethal dose, for example, when ingesting morphine 0.5-1 g.

Opiates

Clinical picture of opioid intoxication: euphoria, pronounced miosis - pupils are constricted, their reaction to light is weakened, skin redness, increased muscle tone or cramps, dry mouth, dizziness, frequent urination.

Stunning gradually increases and coma develops. Breathing is depressed, slow, shallow. Death occurs due to paralysis of the respiratory center.

Urgent Care: turn the victim on his side or stomach, clear the airways of mucus and vomit; bring a cotton swab with ammonia to your nose; call an ambulance; Before the arrival of doctors, monitor the breathing pattern; if the breathing rate decreases less than 8-10 times per minute, begin artificial respiration.

Repeated gastric lavage with activated carbon or potassium permanganate (1:5000), forced diuresis, saline laxative. Oxygen therapy, mechanical ventilation. Warming. The drug of choice is a morphine antagonist - naloxone, 1 ml IM (to restore breathing); in the absence - nalorphine, 3-5 ml of 0.5% solution i.v. For bradycardia - 0.5-1 ml of 0.1% atropine solution, for OL - 40 mg of Lasix.

Alcohol poisoning occurs as a result of taking large quantities of alcohol (more than 500 ml of vodka) and its surrogates. In sick, weakened, overtired people, and especially in children, even small doses of alcohol can cause poisoning.

Ethyl alcohol belongs to a number of narcotic drugs and has a depressant effect on the central nervous system. The lethal dose when taken orally for adults is about 1 liter of 40% solution, but in people who abuse alcohol or regularly use it, the lethal dose can be much higher. The lethal blood alcohol concentration is about 3-4%.

Symptoms: mental disturbances (excitement or depression), increased heart rate, increased blood pressure, dizziness, nausea, vomiting.

Patients who are unconscious or even comatose need medical care.

The causes of death are respiratory disorders (most often mechanical asphyxia), o. cardiovascular failure, collapse.

Urgent Care: turn the patient on his side and clear the airways of mucus and vomit; rinse the stomach; put cold on your head; bring a cotton swab with ammonia to your nose: call an ambulance.

Flushing the stomach through a thick tube with small portions of warm water with the addition of sodium bicarbonate or a weak solution of potassium permanganate. In case of sharp depression of consciousness, tracheal intubation is first performed to prevent aspiration of vomit; if intubation is impossible, gastric lavage is not recommended for patients in a coma. To restore impaired breathing, 2 ml of 10% caffeine benzoate solution, 1 ml of 0.1% atropine or cordiamine solution on glucose are administered intravenously. To accelerate the oxidation of alcohol in the blood, 500 ml of 20% glucose solution, 3-5 ml of 5% thiamine bromide solution, 3-5 ml of 5% pyridoxine hydrochloride solution, 5-10 ml of 5% solution are administered intravenously. -ra ascorbic acid.

Antihistamines

The severity of poisoning depends both on the dose of the drug taken and on the degree of individual sensitivity to it.

The first symptoms appear after 10-90 minutes. from the moment of taking the drug. Intoxication is manifested by lethargy, drowsiness, unsteady gait, incoherent slurred speech, and dilated pupils. Dry mouth occurs due to poisoning diphenhydramine- numbness of the oral cavity.

In case of moderate poisoning, a short period of stunning is replaced by a state of psychomotor agitation, ending after 5-7 hours with restless sleep. Throughout the entire period of intoxication, dry skin and mucous membranes, tachycardia and tachypnea persist.

A severe form of poisoning is accompanied by arterial hypotension, respiratory depression and ends in sleep or coma. In the initial period of intoxication, convulsive twitching of the muscles of the face and limbs is noted. Attacks of general tonic-clonic seizures are possible.

Urgent Care. Gastric lavage, administration of saline laxative, cleansing enema. To relieve seizures - Seduxen, 5-10 mg IV; when excited - aminazine or tizercin intramuscularly. Physostigmine (s.c.), or galantamine (s.c.), aminostigmine (i.v. or i.m.) is indicated.

Clonidine

The clinical picture of clonidine poisoning includes depression of the central nervous system up to coma, bradycardia, collapse, miosis, dry mouth, dizziness, and weakness.

Urgent Care. Gastric lavage, administration of adsorbents, forced diuresis. For bradycardia - atropine 1 mg IV with 20 ml of 40% glucose solution. For collapse - 30-60 mg prednisolone IV.

The following goals are pursued:
a) identification of a toxic substance;
b) immediate removal of poison from the body;
c) neutralization of poison with the help of antidotes;
d) maintaining the basic vital functions of the body (symptomatic treatment).

First aid.

Removing poison. If the poison has entered through the skin or external mucous membranes (wound, burn), it is removed with a large amount of water - saline, weak alkaline (baking soda) or acidic solutions (citric acid, etc.). If toxic substances get into cavities (rectum, vagina, bladder), they are washed with water using an enema or douching. Poison is removed from the stomach by lavage (flushing technique through a tube - see Chapter XX, Nursing), emetics, or reflexively inducing vomiting by tickling the throat. It is forbidden to induce vomiting in an unconscious state and in those poisoned by cauterizing poisons. Before reflexively inducing vomiting or taking emetics, it is recommended to drink several glasses of water or 0.25 - 0.5% sodium bicarbonate solution (baking soda), or 0.5% potassium permanganate solution (pale pink solution), warm solution of table salt (2-4 teaspoons per glass of water). Ipecac root and others are used as emetics, soapy water or mustard solution can be used. Poison is removed from the intestines with laxatives. The lower segment of the intestine is washed with high siphon enemas. Those who are poisoned are given plenty of fluids to drink, and diuretics are prescribed for better urine output.

Neutralization of poison. Substances that enter into a chemical combination with a poison, transforming it into an inactive state, are called antidotes, so an acid neutralizes an alkali and vice versa. Unithiol is effective against cardiac glycoside poisoning and alcoholic delirium. Antarsin is effective against poisoning with arsenic compounds, in which the use of unithiol is contraindicated. Sodium thiosulfate is used for poisoning with hydrocyanic acid and its salts, which in the process of chemical interaction turn into non-toxic thiocyanate compounds or cyanohydrides, which are easily removed in the urine.

The ability to bind toxic substances is possessed by: activated carbon, tannin, potassium permanganate, which are added to the wash water. For the same purpose. use plenty of milk, protein water, egg whites (according to indications).

Enveloping agents (up to 12 egg whites per 1 liter of boiled cold water, vegetable mucus, jelly, vegetable oil, an aqueous mixture of starch or flour) are especially indicated for poisoning with irritating and cauterizing poisons, such as acids, alkalis, salts of heavy metals.

Activated carbon is administered orally in the form of an aqueous slurry (2-3 tablespoons per 1-2 glasses of water), has a high sorption capacity for many alkaloids (atropine, cocaine, codeine, morphine, strychnine, etc.), glycosides (strophanthin, digitoxin, etc.) etc.), as well as microbial toxins, organic and, to a lesser extent, inorganic substances. One gram of activated carbon can adsorb up to 800 mg of morphine, up to 700 mg of barbiturates, and up to 300 mg of alcohol.

Vaseline oil (3 ml per 1 kg of body weight) or glycerin (200 ml) can be used as agents that accelerate the passage of poison through the gastrointestinal tract and prevent absorption. ).

Methods for accelerated removal of poison from the body.

Active detoxification of the body is carried out in specialized centers for the treatment of poisoning. The following methods are used.

1. Forced diuresis - based on the use of diuretics (urea, manpitol, Lasix, furosemide) and other methods that promote increased urine output. The method is used in most cases of intoxication, when toxic substances are eliminated primarily by the kidneys.

Water load is created by drinking plenty of alkaline water (up to 3-5 liters per day) in combination with diuretics. Patients in a comatose state or with severe dyspeptic disorders are given a subcutaneous or intravenous injection of sodium chloride solution or glucose solution. Contraindications to water exercise are acute cardiovascular failure (pulmonary edema) or renal failure.

Alkalinization of urine is created by intravenous drip administration of sodium bicarbonate solution up to 1.5-2 liters per day under the control of determining the alkaline reaction of urine and reserve alkalinity of the blood. In the absence of dyspeptic disorders, you can give sodium bicarbonate (baking soda) orally, 4-5 g every 15 minutes for an hour, then 2 g every 2 hours. Alkalinization of urine is a more active diuretic than water loading, and is widely used for acute poisoning with barbiturates, salicylates, alcohol and its surrogates. Contraindications are the same as for water loading.

Osmotic diuresis is created by intravenous administration of osmotically active diuretic drugs, which significantly enhance the process of reabsorption in the kidneys, which allows for the excretion in the urine of a significant amount of poison circulating in the blood. The most well-known drugs in this group are: hypertonic glucose solution, urea solution, mannitol.

2. Hemodialysis is a method that uses an artificial kidney apparatus as an emergency measure. The rate of purification of blood from poisons is 5-6 times higher than forced diuresis.

3. Peritoneal dialysis - accelerated elimination of toxic substances that have the ability to accumulate in fatty tissues or bind tightly to blood proteins. During peritoneal dialysis surgery, 1.5-2 liters of sterile dialysate fluid is injected through a fistula sewn into the abdominal cavity, changing it every 30 minutes.

4. Hemosorption is a method of perfusion (distillation) of a patient’s blood through a special column with activated carbon or other sorbent.

5. Blood replacement surgery is performed in case of acute poisoning with chemicals that cause toxic damage to the blood. 4-5 liters of single-group, Rh-compatible, individually selected donor blood are used.

Resuscitation measures and symptomatic treatment.

Poisoned people require the most careful observation and care in order to take timely measures against threatening symptoms. In case of a decrease in body temperature or cold extremities, patients are wrapped in warm blankets, rubbed, and given a hot drink. Symptomatic therapy is aimed at maintaining those functions and systems of the body that are most damaged by toxic substances. Below are the most common complications from the respiratory system, gastrointestinal tract, kidneys, liver, and cardiovascular system.

a) Asphyxia (suffocation) in a comatose state.

The result of tongue retraction, aspiration of vomit, sharp hypersecretion of bronchial glands and salivation.

Symptoms: cyanosis (blue discoloration), a large amount of thick mucus in the oral cavity, weakened breathing and coarse moist rales over the trachea and large bronchi are heard.

First aid: remove vomit from the mouth and pharynx with a swab, remove the tongue with a tongue holder and insert an air duct.

Treatment: for severe salivation, subcutaneous injection of 1 ml of 0.1% atropine solution.

b) Burn of the upper respiratory tract.

Symptoms: with laryngeal stenosis - hoarseness or loss of voice (aphonia), shortness of breath, cyanosis. In more severe cases, breathing is intermittent, with convulsive contraction of the neck muscles.

First aid: inhalation of sodium bicarbonate solution with diphenhydramine and ephedrine.

Treatment: emergency tracheotomy.

c) Breathing disorders of central origin, due to depression of the respiratory center.

Symptoms: chest excursions become superficial, arrhythmic, until they stop completely.

First aid: mouth-to-mouth artificial respiration, closed heart massage (see Chapter 1, Internal Medicine, Section 2, Sudden Death).

Treatment: artificial respiration. Oxygen therapy.

d) Toxic pulmonary edema occurs with burns of the upper respiratory tract due to vapors of chlorine, ammonia, strong acids, as well as poisoning with nitrogen oxides, etc.

Symptoms. Little noticeable manifestations (cough, chest pain, palpitations, isolated wheezing in the lungs). Early diagnosis of this complication is possible using fluoroscopy.

Treatment: prednisolone 30 mg up to 6 times a day intramuscularly, intensive antibiotic therapy, large doses of ascorbic acid, aerosols using an inhaler (1 ml diphenhydramine + 1 ml ephedrine + 5 ml novocaine), for hypersecretion subcutaneously - 0.5 ml 0.1 % atropine solution, oxygen therapy (oxygen therapy).

d) Acute pneumonia.

Symptoms: increased body temperature, decreased breathing, moist rales in the lungs.

Treatment: early antibiotic therapy (daily intramuscular injection of at least 2,000,000 units of penicillin and 1 g of streptomycin).

f) Decrease in blood pressure.

Treatment: intravenous drip administration of plasma replacement fluids, hormonal therapy, and cardiovascular drugs.

g) Heart rhythm disturbances(decrease in heart rate to 40-50 per minute).

Treatment: intravenous administration of 1-2 ml of 0.1% atropine solution.

h) Acute cardiovascular failure.

Treatment: intravenously - 60-80 mg of prednisolone with 20 ml of 40% glucose solution, 100-150 ml of 30% urea solution or 80-100 mg of Lasix, oxygen therapy (oxygen).

i) Vomiting.

In the early stages of poisoning it is considered as a favorable phenomenon, because helps remove poison from the body. The occurrence of vomiting in an unconscious state of the patient, in young children, in case of respiratory failure, is dangerous, because Possible entry of vomit into the respiratory tract.

First aid: place the patient on his side with his head slightly lowered, remove vomit from the mouth with a soft swab.

j) Painful shock from a burn of the esophagus and stomach.

Treatment: painkillers and antispasmodics (2% promedol solution - 1 ml subcutaneously, 0.1% atropine solution - 0.5 ml subcutaneously).

l) Esophageal-gastric bleeding.

Treatment: locally on the abdomen with an ice pack, intramuscular hemostatic agents (1% vikasol solution, 10% calcium gluconate solution).

l) Acute renal failure.

Symptoms: sudden decrease or cessation of urination, swelling of the body, increased blood pressure.

Providing first aid and effective treatment is possible only in specialized nephrology or toxicology departments.

Treatment: control the amount of fluid administered and the volume of urine excreted. Diet No. 7. The complex of therapeutic measures includes intravenous administration of a glucose-novocain mixture, as well as alkalization of the blood with intravenous injections of 4% sodium bicarbonate solution. Hemodialysis (artificial kidney machine) is used.

m) Acute liver failure.

Symptoms: enlarged and painful liver, its functions are impaired, which is determined by special laboratory tests, yellowness of the sclera and skin.

Treatment: diet N 5. Drug therapy - methionine in tablets up to 1 gram per day, lipocaine in tablets 0.2-0.6 grams per day, B vitamins, glutamic acid in tablets up to 4 grams per day. Hemodialysis (artificial kidney machine).

o) Trophic complications.

Symptoms: redness or swelling of certain areas of the skin, the appearance of “pseudo-burn blisters”, subsequent necrosis, rejection of the affected areas of the skin.

Prevention: constant replacement of wet underwear, treating the skin with camphor alcohol solution, regularly changing the position of the patient in bed, placing cotton-gauze rings under protruding areas of the body (sacrum, shoulder blades, feet, back of the head).

MOST COMMON POISONINGS

Section 2. ACUTE MEDICINE POISONING

Sleeping pills (barbiturates)

All derivatives of barbituric acid (phenobarbital, barbital, medinal, etaminal-patriy, Sereysky's mixture, tardil, bellaspon, bromital, etc.) are absorbed quite quickly and almost completely in the gastrointestinal tract.

Lethal dose: about 10 medical doses with large individual differences.

Acute poisoning by sleeping pills is primarily accompanied by depression of the functions of the central nervous system. The leading symptom is respiratory failure and the progressive development of oxygen starvation. Breathing becomes rare and intermittent. All types of reflex activity are suppressed. The pupils first narrow and react to light, and then (due to oxygen starvation) they dilate and no longer react to light. Kidney function suffers sharply: a decrease in diuresis contributes to the slow release of barbiturates from the body. Death occurs as a result of paralysis of the respiratory center and acute circulatory disorders.

There are 4 clinical stages of intoxication.

Stage 1 - “falling asleep”: characterized by sniffling, apathy, decreased reactions to external stimuli, but contact with the patient can be established.

Stage 2 - “superficial coma”: loss of consciousness is noted. Patients may respond to painful stimulation with a weak motor reaction and short-term dilation of the pupils. Swallowing becomes difficult and the cough reflex weakens, and breathing problems occur due to the retraction of the tongue. An increase in body temperature to 39-40°C is typical.

Stage 3 - “deep coma”: characterized by the absence of all reflexes, there are signs of a threatening violation of the vital functions of the body. Breathing disorders from superficial, arrhythmic to complete paralysis, associated with inhibition of the central nervous system, come to the fore.

In stage 4, the “post-comatose state,” consciousness is gradually restored. On the first day after awakening, most patients experience tearfulness, sometimes moderate psychomotor agitation, and sleep disturbance.

The most common complications are pneumonia, tracheobronchitis, and bedsores.

Treatment. Sleeping pill poisoning requires emergency treatment. First of all, it is necessary to remove poison from the stomach, reduce its content in the blood, and support breathing and the cardiovascular system. Poison is removed from the stomach by washing it (the earlier the washing is started, the more effective it is), spending 10-13 liters of water; repeated washing is advisable, preferably through a tube. If the victim is conscious and there is no probe, rinsing can be done by repeatedly taking several glasses of warm water, followed by inducing vomiting (irritation of the pharynx). Vomiting can be induced with mustard powder (1/2-1 teaspoon per glass of warm water), table salt (2 tablespoons per glass of water), warm soapy water (one glass) or an emetic, including apomorphine subcutaneously (1 ml 0 ,5%).

To bind poison in the stomach, activated carbon is used, 20-50 g of which is injected into the stomach in the form of an aqueous emulsion. The reacted charcoal (after 10 minutes) must be removed from the stomach, since the adsorption of the poison is a reversible process. That part of the poison that has passed into the stomach can be removed with the help of laxatives. Preference is given to sodium sulfate (Glauber's salt), 30-50 g. Magnesium sulfate (bitter salt) in case of impaired renal function can have a depressant effect on the central nervous system. Castor oil is not recommended.

To accelerate the elimination of absorbed barbiturates and their excretion by the kidneys, give plenty of fluids and diuretics. If the patient is conscious, then liquid (plain water) is taken orally; in cases of severe poisoning, a 5% glucose solution or an isotonic sodium chloride solution is administered intravenously (up to 2-3 liters per day). These measures are carried out only in cases where the excretory function of the kidneys is preserved.

To accelerate the removal of poison and excess fluid, a fast-acting diuretic is prescribed intravenously. In case of severe respiratory distress, intubation, suction of bronchial contents and artificial ventilation are carried out; in case of less significant respiratory distress, the use of respiratory stimulants (analeptics) is used. To prevent pneumonia, antibiotics are prescribed; in case of a sharp increase in temperature, 10 ml of a 4% amidopyrine solution is prescribed intramuscularly. Vasoconstrictors are used to restore vascular tone. To stimulate cardiac activity, fast-acting glycosides are used; in case of cardiac arrest, the injection of adrenaline into the cavity of the left ventricle, followed by massage through the chest, is indicated.

Antidepressive drugs

The group of atidepressants includes imizin (imipramine), amitriptyline, azaphen, fluoroacyzine, etc. They are well absorbed in the gastrointestinal tract, easily bind to proteins in the blood and organs, and are quickly distributed throughout the body, producing a toxic effect.

The prognosis is always serious and mortality when taking more than 1 g exceeds 20%.

Symptoms. Characteristic changes occur in the central and cardiovascular systems. Already early after poisoning, psychomotor agitation occurs, hallucinations appear, body temperature drops sharply, and coma develops with respiratory depression. Acute cardiopathy and cardiac arrest are the main causes of death in these poisonings. The main manifestations of toxic effects on the myocardium are expressed during the first 12 hours, but can develop over the next 6 days.

The severity of poisoning is manifested by a sharp dilation of the pupils, dryness of the oral mucosa, impaired motility of the gastrointestinal tract up to intestinal paresis.

First aid. Gastric lavage with a solution of sodium bicarbonate (baking soda), a solution of table salt or water with activated carbon. Washing is carried out in the first 2 hours after poisoning, and then again. At the same time, a saline laxative is administered and a cleansing enema is performed. Emetics and artificial respiration are used if respiratory failure occurs. Cardiac glycosides are contraindicated, since the toxicity of tricyclic antidepressants increases sharply.

Hypertensin is used to correct vascular tone. To relieve seizures and psychomotor agitation, it is advisable to use barbiturates and aminazine. The main drug that provides an antidote effect is physostigmine, which is administered intravenously. The criterion for its effectiveness is a decrease in heart rate to 100-120 beats per minute and an increase in blood pressure (100/80 mm Hg).

Tranquilizers

Drugs in this group include meprotan (Andaxin, Meprobamate), diazepam (Seduxen, Relanium, Valium), nitrazepam, trioxazine, Elenium, Librium and other drugs that have a pronounced tranquilizing or sedative effect. All substances are easily absorbed from the gastrointestinal tract and form strong compounds with blood and tissue proteins.

Symptoms. The clinical picture manifests itself in depression of the central nervous system. Against the background of muscle weakness, there is tremor (shaking) of the limbs, heart rhythm disturbances, and a drop in blood pressure. Motility increases or peristalsis of the gastrointestinal tract is sharply inhibited, combined with a decrease in salivary secretion and a feeling of dry mouth.

In severe poisoning, symptoms from the central nervous system predominate: confusion, psychomotor agitation, hallucinations, convulsions. From the cardiovascular system - tachycardia, tendency to collapse; respiratory distress, cyanosis.
First aid. Early frequent and repeated gastric lavage with activated charcoal, saline laxative, siphon enema. The role of conservative therapy in order to maintain vital functions is great: the use of vasoconstrictors in case of severe circulatory failure, the introduction of cardiac drugs (strophanthin, cocarboxylase, korglykon), the introduction of alkaline solutions, correction of convulsive conditions and external respiration, including oxygen therapy.

Central nervous system stimulants

The caffeine group and its apologists (theophylline, theobromine, aminophylline, aminophylline, theophedrine, diprophylline, etc.). Of the entire group, caffeine has the greatest stimulating effect, the toxic dose of which is at the level of 1 g, and the lethal dose is about 20 g, with large individual differences. With intravenous administration of aminophylline, there are cases of death from a dose of about 0.1 g, lethal doses in children when administered in suppositories are 25-100 mg/kg.

Symptoms. The main signs of toxic effects with long-term use of relatively large doses (for example, in people who abuse coffee and tea) are manifested in irritability, anxiety, excitability, persistent headaches that are difficult to respond to drug therapy, and sleep disorders. The effect on the gastrointestinal tract is manifested by a burning sensation in the epigastric region, nausea, vomiting, a sharp increase in gastric secretion, which is especially dangerous for patients with ulcers, and constipation.

Acute caffeine poisoning is expressed in psychomotor reactions that turn into delirium and hallucinations, there are disturbances in sensory functions (determining time and distance) and movement speed. The initial phase of excitation is quickly replaced by a soporous state. The most dangerous complication of caffeine and its analogues is the development of acute cardiovascular failure with symptoms of collapse. Heart paralysis is also possible with rapid injection of aminophylline into a vein.

First aid. Gastric lavage with a 1-2% solution of tannin or sodium bicarbonate (baking soda), a suspension of activated carbon. If poisoning is caused by suppositories containing aminophylline, give an enema and take a saline laxative.

To relieve psychomotor agitation and seizures, use chloral hydrate in an enema (1.5-2 g per 50 ml of water), aminazine (2 ml of a 2.5% solution with novocaine), diphenhydramine (1 ml of a 2% solution with novocaine) - intramuscularly.

Correction of cardiovascular failure in case of caffeine poisoning is difficult in the conditions of first aid, since most vasoconstrictors will enhance the toxic effect of caffeine and its analogues. It is advisable to carry out this type of resuscitation in a hospital setting, where an exchange transfusion of blood (plasma) can be performed and forced diuresis with alkalization can be used.

Strychnine. Lethal dose: 0.2-0.3 g. Strychnine is easily absorbed from the gastrointestinal tract and also easily penetrates the body from all injection sites.

Symptoms: agitation, headaches, shortness of breath. Increased tone of the occipital muscles, trismus of the masticatory muscles, tetanic convulsions at the slightest irritation. Spasm of the respiratory muscles with the development of severe chest rigidity. Death occurs due to asphyxia (suffocation).

Treatment. If poison is ingested, early gastric lavage, saline laxative, chloral hydrate in enema again. Sedative therapy: barbamyl (3-5 ml of 10% solution) into a vein, morphine (1 ml of 1% solution), diphenhydramine (2 ml of 1% solution) under the skin. In case of breathing problems, intubation anesthesia using muscle relaxants (listenone, diplacin). Forced diuresis (alkalinization of urine).

Narcotic drugs

Indian hemp (hashish, plan) is a narcotic intoxicant. It is used for chewing, smoking and ingestion for the purpose of a kind of intoxication. The toxic effect is associated with depression of the central nervous system.

Symptoms. Initially, psychomotor agitation, dilated pupils, tinnitus, vivid visual hallucinations (seeing colors, large spaces), rapid changes of thoughts, laughter, and ease of movements are characteristic. Then comes general weakness, lethargy, a tearful mood and long, deep sleep with a slower pulse and a drop in body temperature.

Treatment. Gastric lavage when taking poison orally. In case of sudden excitement - aminazine (1-2 ml of 2.5% solution) intramuscularly, chloral hydrate in an enema, cardiovascular drugs.

Nicotine is a tobacco alkaloid. Lethal dose - 0.05 g.

Symptoms: if poison gets inside the mouth, behind the sternum and in the epigastric region - a feeling of itching, areas of numbness of the skin, dizziness, headache, visual and hearing disturbances. Dilated pupils, pale face, drooling, repeated vomiting. Shortness of breath with difficulty exhaling, rapid heartbeat, irregular pulse, fibrillary twitching of individual muscle groups with the development of general clonic-tonic convulsions. During seizures, there is an increase in blood pressure followed by a drop. Loss of consciousness. Cyanosis of the mucous membranes.

Death occurs due to paralysis of the respiratory center and respiratory muscles.

Cardiac arrest in diastole. When taking toxic doses, the picture of poisoning develops quickly.

Treatment. Activated carbon orally, followed by copious gastric lavage with a solution of potassium permanganate (1:1000), saline laxative. Cardiovascular drugs (caffeine, cordiamine). Novocaine with glucose into a vein drip, magnesium sulfate intramuscularly, diphenhydramine under the skin. For convulsions with difficulty breathing - 10% solution of barbamyl (or 2.5% solution of hexenal or sodium thiopental) 5-10 ml into a vein slowly at intervals of 20-30 seconds until the convulsions stop or 1% solution of chloral hydrate in an enema.

If these measures are unsuccessful, ditilin (or other similar drugs) is given into a vein, followed by intubation and artificial respiration. In case of heart rhythm disturbances such as tachycardia - cardiac glycosides, in case of a sharp slowdown in pulse - atropine and calcium chloride solution intravenously. Oxygen therapy.

Morphine group. Lethal dose: 0.1-0.2 g orally.

Symptoms. When toxic doses of drugs are taken orally or intravenously, a coma develops, which is characterized by significant constriction of the pupils with a weakened reaction to light. Characteristic is the predominant depression of the respiratory center - respiratory paralysis even with a shallow coma or with the patient’s consciousness preserved (in case of codeine poisoning). There may also be a significant drop in blood pressure. Death occurs as a result of inhibition of the respiratory center.

First aid: gastric lavage with warm solutions of potassium permanganate (as it oxidizes morphine) with the addition of activated charcoal, saline laxative. Do not allow the poisoned person to sleep, hot baths with cold douches, or rubbing. Hot water bottles on your head, arms and legs.

Treatment. Repeated gastric lavage, even with intravenous morphine. Nalorphine (anthorphine) 1-3 ml of 0.5% solution into a vein again. Forced diuresis (alkalinization of urine). Cardiovascular drugs according to indications. Antibiotics. Vitamin therapy. Artificial ventilation.

Anti-inflammatory and antipyretic drugs

The most common of them belong to three different chemical groups: salicylates (products containing acetylsalicylic acid), pyrazolones (amidopyrine, analgin, butadione) and anilines (paracetamol and phenacetin). Each group has its own side effects, but the picture of poisoning has quite a lot of similarities.

Aspirin, askafen and other salicylates. Lethal dose: 30-50 g, for children - 10 g.

Symptoms. When salicylic acid is taken orally, especially an alcohol solution, a burning sensation and pain occurs along the esophagus, in the stomach, repeated vomiting, often with blood, and sometimes loose stools mixed with blood. Typical symptoms include tinnitus, hearing loss, and visual impairment. Patients are excited and euphoric. Breathing is noisy, rapid, and a coma may occur. Salicylates reduce blood clotting, so hemorrhages on the skin, profuse (massive) nasal and uterine bleeding are a constant sign of poisoning. The prognosis is usually favorable for life.

Treatment. After washing the stomach through a tube, Vaseline oil (a glass) is injected inside, and a laxative is given - 20-30 g of sodium sulfate (Glauber's salt). Increased alkaline drinking of sodium bicarbonate (baking soda) or in an enema (at the rate of 0.4 g/kg body weight) every hour until normal breathing rate is restored and an alkaline urine reaction appears.

Prescribing large doses of ascorbic acid (up to 0.5-1 g) per day orally or by injection accelerates the neutralization of salicylic acid. In case of bleeding - Vicasol, calcium chloride, blood transfusion. Treatment of renal and liver failure, burns of the digestive tract.

Analgin, amidopyrine and other pyrazolone derivatives. Lethal dose: 10-15 g.

Symptoms: tinnitus, nausea, vomiting, general weakness, decreased temperature, shortness of breath, palpitations. In severe poisoning - convulsions, drowsiness, delirium, loss of consciousness and coma. The development of peripheral edema, gastric bleeding, and hemorrhagic rash is possible.

Treatment. The main measures are the same as for poisoning with salicylates: gastric lavage, laxatives, copious brush drinks, diuretics. Additionally, anticonvulsant treatment is possible - chloral hydrate 1 g in an enema with starchy mucus, barbamyl intramuscularly, diazepam intravenously. In case of convulsions, it is better to avoid analeptics, using strophanthin or similar means to stimulate the heart. It is mandatory to prescribe potassium chloride or acetate orally, 0.5-1 g in 1-2 doses.

Paracetamol and other aniline derivatives. The symptoms of irritation of the digestive tract during poisoning are less pronounced, but the signs of the formation of methemoglobin in the blood are more significant - pallor, cyanosis, brownish-brown skin color. In severe cases - dilated pupils, shortness of breath, convulsions, vomiting with the smell of aniline. At a later stage, anemia and toxic nephritis develop. The prognosis is usually favorable.

Treatment is the same as in previous cases. However, severe methemoglobinemia often forces one to resort to exchange transfusion. More attention should be paid to combating renal dysfunction (osmotic diuresis or furosemide with abundant fluid and mineral salts).

Antiseptics

Iodine. Lethal dose: 2-3 g. Symptoms: brown staining of the tongue and oral mucosa, vomiting of brown and blue masses (if there is starch in the stomach contents), diarrhea. Headache, runny nose, skin rashes. Irritation of the mucous membrane of the respiratory tract. In severe cases - pulmonary edema, convulsions, small rapid pulse, coma.

First aid: gastric lavage, orally - liquid starch or flour paste in large quantities, milk, mucous drink, laxative - burnt magnesia (magnesium oxide).

Treatment: 1% sodium thiosulfate solution orally in an amount of 250-300 ml. Symptomatic therapy, treatment of burns of the digestive tract.

Potassium permanganate (potassium permanganate). Lethal dose: 0.5-1 g.

Symptoms: sharp pain in the mouth, along the esophagus, in the abdomen. Diarrhea, vomiting. The mucous membrane of the oral cavity is dark brown. Laryngeal edema, burn shock, convulsions.

First aid and treatment - see Strong acids.

Hydrogen peroxide. Symptoms: in case of contact with the skin - whitening, burns, blisters. If ingested - burns the digestive tract. Treatment - see Iodine.

Ethyl alcohol (wine alcohol) is a component of alcoholic beverages, perfumes, cologne, lotions, medicinal herbal tinctures, and is a solvent for alcohol varnishes, alkaline polishes, BF brand adhesives, etc. Lethal concentration of ethyl alcohol in the blood: about 300-400 mg%.

Symptoms. With mild intoxication, the leading symptom is euphoria (elevated mood). With moderate intoxication, disturbances in gait and coordination of movements, moderate excitement, which is replaced by drowsiness and deep sleep, occur. These stages of intoxication do not require treatment.

In severe poisoning, all phenomena are more pronounced and intoxication ends with anesthesia, i.e. deep sleep with loss of all types of sensitivity, including pain and temperature. And although this condition in itself is not life-threatening, since it goes away after a few hours, but in a state of anesthesia, severe injuries are possible, the occurrence of deep bedsores, even gangrene of soft tissues, caused by impaired local circulation when sleeping in the same uncomfortable position . Hypothermia poses a significant danger. It can occur even at an air temperature of 12°C. In this case, the body temperature drops to 31-32°C, the pulse slows down to 28-52 beats, breathing is suppressed to 8-10 per minute. Such a combined lesion is very dangerous and can lead to death either in the first day from respiratory failure or in the coming weeks from pneumonia and gangrene of the lungs caused by hypothermia.

With very severe alcohol intoxication, the patient quickly goes through all the previous stages of intoxication (euphoria, excitement, anesthesia) and falls into a deep coma. There are three stages of coma.

Superficial coma 1: The pupils are constricted with temporary dilation during painful stimulation. There is a strong smell of alcohol from the mouth. Patients respond to inhalation of ammonia with a facial reaction and protective hand movements. This stage of alcohol intoxication has the most favorable course and often after gastric lavage through a tube, patients regain consciousness.

Superficial coma 2: characterized by severe muscle hypotonia (relaxation) with preserved reflexes (tendon, pupillary). They react poorly to inhalation irritation with ammonia vapor. These patients are subject to hospitalization, since the coma is longer and measures to stop further absorption of alcohol (gastric lavage through a tube) are not accompanied by a rapid restoration of consciousness.

Deep coma: characterized by a complete absence of reflex activity. The pupils are constricted or, in cases of respiratory failure, dilated. There is no pain sensitivity or reaction to irritation with ammonia.

It must be remembered that alcohol intoxication can be accompanied by respiratory failure due to retraction of the tongue, aspiration of mucus and vomit into the respiratory tract, and increased secretion of the bronchial glands. Impaired function of the cardiovascular system manifests itself in the form of moderate hypertension, followed by hypotension (low blood pressure) and severe tachycardia in the stage of deep coma.

Recognition. Alcoholic coma should be distinguished from stroke, uremic coma, morphine poisoning and its derivatives. The smell of alcohol on the breath does not prove anything, since combined lesions are possible.

A stroke is most often accompanied by paralysis of half the body with deviation of the eye towards the lesion and nystagmus. In this case, the coma is deeper than alcoholic coma and usually occurs suddenly.

With uremia, the smell of ammonia from the mouth is characteristic; the pupils either narrow to medium size or dilate. Diuresis is absent or extremely scanty, while in an alcoholic coma, diuresis, on the contrary, is increased, vomiting, involuntary urination and defecation are common.

Morphine coma is characterized by a sharp narrowing of the pupil to the size of a “pinhead”, preserved tendon reflexes.

The leading sign for diagnosis in a difficult case is determining the amount of alcohol in the blood, which is only possible in a specialized hospital. An alcoholic coma is usually short-lived, lasting only a few hours. Its duration of more than a day in combination with sudden breathing difficulties is an unfavorable sign.

First aid. In a very serious condition (coma), it should be energetic, especially if breathing is impaired.

When blood pressure drops, cardiovascular drugs are prescribed (cordiamine, ephedrine, strophanthin), polyglucin and prednisolone are administered intravenously.

The main thing when treating intoxication is to stop the absorption of alcohol and rinse the stomach abundantly through a tube. It is also removed from the body by intravenous administration of a hypertonic glucose solution with insulin; in a deep coma, it is advisable to use the method of forced diuresis and vitamin therapy. Analeptics and, in particular, bemefid are contraindicated in the stage of severe alcoholic coma. Of the emetics, only apomorphine subcutaneously is used, but it is also contraindicated in the absence of consciousness, as well as in low blood pressure, severe general exhaustion, which is often found in alcoholics.

To restore consciousness, an ammonia solution is also used orally (5-10 drops of ammonia per glass of water). Since the patient develops acidosis (“blood acidification”), it is necessary to inject a solution of sodium bicarbonate into a vein or orally (2-7 g of baking soda per dose). Warming the patient with heating pads is mandatory, especially when intoxication is combined with cooling. When agitated, barbiturates or morphine-type drugs should not be given to calm the patient because of the risk of respiratory depression. In this case, aminazine or chloral hydrate should be administered no more than 0.2-0.5 g in an enema with starch mucus. The patient should be given hot, strong, sweet tea or coffee; the caffeine contained in these drinks helps stimulate breathing, the cardiovascular system and awakening.

Alcohol substitutes:

Methyl alcohol is less toxic than ethyl alcohol, but in the process of its oxidation, extremely toxic products (formic acid and formaldehyde) are formed in the body, which cause delayed and very serious consequences. Individual sensitivity to methyl alcohol varies even more than to ethyl alcohol; the minimum dose for a person is considered to be 100 ml. Mortality from methyl alcohol poisoning is significant.

Symptoms and course. At very large doses, poisoning can occur at lightning speed. In this case, all phenomena similar to severe alcohol intoxication (euphoria, coordination disorders, excitement) develop much faster, and death can occur within 2-3 hours. With relatively small doses of methyl alcohol, poisoning develops as a latent period.

In mild forms of poisoning, headache, nausea, persistent vomiting, pain in the stomach, dizziness and moderate visual impairment appear: flashing “spots” before the eyes, blurred vision - “fog before the eyes”. These phenomena last from 2 to 7 days and then disappear.

With a moderate form of poisoning, the same phenomena are observed, but more pronounced, and after 1-2 days blindness occurs. In this case, vision is slowly restored at first, but not completely, and after a while it worsens again. The prognosis for life is good, but for vision is poor. An unfavorable sign is persistent pupil dilation.

The severe form begins in the same way, but then drowsiness and stupor appear, after 6-10 hours pain in the legs and head may appear, and thirst increases. The skin and mucous membranes are dry, inflamed, with a bluish tint, the tongue is coated with a gray coating, the breath smells of alcohol. The pulse is frequent, with a gradual slowdown and rhythm disturbance, blood pressure is increased with its subsequent drop. Consciousness becomes confused, psychomotor agitation occurs, and convulsions are possible. Sometimes a coma, stiff neck, and hypertonicity of the muscles of the extremities quickly develop. Death occurs from respiratory paralysis and a decline in cardiovascular activity.

Treatment. Similar to that for an alcoholic coma: gastric lavage followed by administration of 20-30 g of sodium sulfate dissolved in a glass of water through a tube. The fight against breathing disorders is inhalation of pure oxygen, and, if necessary and possible, artificial ventilation of the lungs. Gastric lavage should be repeated several times over 2-3 days, since methyl alcohol is absorbed from the gastrointestinal tract slowly. In the first hours after poisoning, the administration of ethyl alcohol in the form of a glass of cognac orally or as a 2-5% solution into a vein dropwise at the rate of up to 1 ml of pure alcohol per 1 kg of the patient’s weight is indicated. The introduction of ethyl alcohol prevents the oxidation of methyl alcohol to formic acid and formaldehyde and accelerates its elimination. To combat eye damage, one should resort to early lumbar punctures and the administration of ATP, atropine, prednisolone, vitamins (retinol, ascorbic acid, thiamine, riboflavin, etc.) in prescribed doses.

Hydrolysis and sulfite alcohols. They are ethyl alcohol obtained from wood by hydrolysis and are 1.11.4 times more toxic than ethyl alcohol due to impurities of methyl alcohol, carbonyl compounds, etc.

Formic alcohol. The nature of the action is close to methyl. Lethal dose is about 150 g. Symptoms - see Methyl alcohol. More often, pronounced psychomotor agitation and a delirium state (like “delirium tremens”) are observed; after 2-4 days, acute renal failure develops.

For treatment, see Methyl alcohol. Treatment of acute renal failure.

Colognes and lotions are cosmetics containing up to 60% ethyl alcohol, methyl alcohol, aldehydes, essential oils and other impurities, which makes them more toxic than ethyl alcohol.

For symptoms, treatment, see Ethyl alcohol.

Polishes are toxic ethyl alcohol containing large amounts of acetone, butyl and amyl alcohols and other impurities. Some types of polishes contain aniline dyes.

For symptoms and treatment, see Ethyl alcohol, Aniline.

BF glue. It is based on phenol-formaldehyde resin and polyvinyl acetal, dissolved in ethyl alcohol, acetone and chloroform. The toxic effect depends on the composition of the adhesive series, the solvent substance, as well as the degree of precipitation and removal of the resin from the solution before ingestion.

Symptoms, treatment - see Ethyl alcohol, methyl alcohol, Acetone.

Antifreeze is a mixture of glycols: ethylene glycol, propylene glycol and polyglycols (brake fluid). The toxic effect of antifreeze is mainly associated with ethylene glycol. The lethal dose of the latter is about 100 ml, i.e. a glass of antifreeze.

Ethylene glycol itself is low-toxic; serious consequences are caused by its metabolites, in particular oxalic acid. It causes acidosis ("acidification of the blood"), and calcium oxalate crystals formed in the urine damage the kidneys.

Symptoms. The phenomenon of mild alcohol intoxication while feeling well. After 5-8 hours, pain appears in the epigastric region and abdomen, severe thirst, headache, vomiting, and diarrhea. The skin is dry and hyperemic. Mucous membranes with a bluish tint. Psychomotor agitation, dilated pupils, increased temperature. Dyspnea. Increased heart rate. In severe poisoning, loss of consciousness, stiff neck, and convulsions occur. Breathing is deep and noisy. Phenomena of acute cardiovascular failure (collapse, pulmonary edema). From 2-3 days after poisoning, symptoms of acute renal failure develop. Yellowness of the skin appears, the liver enlarges and becomes painful. Poisoned persons may die due to symptoms of increasing uremia.

Recognition. The diagnostic sign is the appearance of calcium oxalate crystals in the urine and the onset of renal symptoms after 2-3 days: pain in the lower back and abdomen, painful urination, urine the color of “meat slop.”

Treatment. Basically the same as for alcohol poisoning: gastric lavage and saline laxative, combating breathing problems and acidosis with a solution of sodium bicarbonate (soda), which is taken orally or administered intravenously.

Specific to this poisoning is the fight against renal dysfunction. To do this, you should prescribe plenty of fluids, osmotic diuretics or furosemide (0.04-0.12 g orally or 23 ml of I% solution into a vein or muscle). When taking diuretics, the loss of water, potassium, sodium and chlorine from the body should be compensated by the accompanying administration of saline plasma replacement solutions in an amount equal to or slightly greater than diuresis. To prevent kidney damage from calcium oxalate, it is necessary to prescribe magnesium sulfate intramuscularly, 5 ml of a 25% solution per day. If there are signs of cerebral edema and meningeal symptoms, a lumbar puncture should be performed. When ingesting more than 200 ml of poison - hemodialysis on the 1st day after poisoning, peritoneal dialysis. With the development of anuria, the prognosis is extremely unfavorable.

Acetone. It is used as a solvent in the production of various varnishes, artificial silk, film, etc. A weak narcotic poison that affects all parts of the central nervous system. Penetrates the body through the respiratory and digestive organs (when taken orally).

Symptoms: the clinical picture is similar to alcohol intoxication. However, the coma does not reach great depths. The mucous membrane of the oral cavity and pharynx is swollen and inflamed. The smell of acetone comes from the mouth. In case of poisoning with acetone vapors, symptoms of irritation of the mucous membranes of the eyes and respiratory tract appear, headaches and fainting are possible. Sometimes there is an enlargement and tenderness of the liver, yellowness of the sclera.

Signs of acute renal failure may appear (decreased diuresis, the appearance of protein and red blood cells in the urine). Bronchitis and pneumonia often develop.

First aid. Remove the victim to fresh air. If you faint, give ammonia to inhale. Peace. Hot tea, coffee. Emergency care and treatment in severe conditions - see Ethyl alcohol (Poisoning with alcohol and its surrogates).

In addition, prevention of acute renal failure, oxygen therapy (oxygen), antibiotics, including inhalation.

Dichloroethane, carbon tetrachloride, trichlorethylene belong to the group of chlorinated hydrocarbons, widely used as solvents in many industries, in everyday life for gluing plastic products, cleaning clothes, etc. The toxic effect of these substances is associated with narcotic effects on the nervous system, sudden degenerative changes in the liver and kidneys. Dichloroethane is the most toxic. The lethal dose when taken orally is 20 ml. Poisoning is possible when poison enters orally, through the respiratory tract or skin.

There are four leading clinical syndromes:

Toxic damage to the central nervous system manifests itself in the early stages after poisoning in the form of dizziness, unsteadiness of gait, and severe psychomotor agitation. In severe cases, a coma develops, a frequent complication of which is respiratory failure such as mechanical asphyxia (bronchorrhea, retraction of the tongue, excessive salivation).

Syndrome of acute gastritis and gastroenteritis, in which there is repeated vomiting with a significant admixture of bile, in severe cases, frequent loose stools, flaky with a specific odor.

Acute cardiovascular failure syndrome is manifested by a persistent drop in blood pressure with absence of pulse in the peripheral arteries and is usually observed against the background of psychomotor agitation or coma. In some cases, a drop in blood pressure is preceded by a short-term increase and sharp tachycardia. The development of cardiovascular failure is typical for dichloroethane poisoning and is a poor prognostic factor, as it usually ends in death within the first 3 days.

Syndrome of acute toxic hepatitis with symptoms of hepatic-renal failure. Toxic hepatitis develops in most patients 2-3 days after poisoning. The main clinical manifestations are liver enlargement, spastic pain in the liver area, yellowness of the sclera and skin. Impaired renal function is manifested by the development of albuminuria of varying degrees. In some patients, during the first week after poisoning, acute renal failure (azotemia, uremia) occurs, which is more typical for carbon cherry chloride poisoning.

Inhalation poisoning with dichloroethane and carbon tetrachloride can give a severe clinical picture; when exposed to carbon tetrachloride vapors, hepatic and renal failure often develops. Causes of death: early - cardiovascular failure (1-3 days) and late - hepatic coma, uremia.

First aid and treatment during a coma are exactly the same as for alcohol poisoning, since in both cases there is deep anesthesia with impaired breathing, circulation and acidosis ("blood acidification"). Kidney damage is treated in the same way as similar disorders due to antifreeze poisoning (see Poisoning with alcohol and its surrogates). To restore liver function, vitamins B and C, glucocorticoids, insulin with glucose are prescribed, treatment is carried out in a hospital late after poisoning.

Turpentine. Solvent for varnishes, paints, raw materials for the production of camphor, terpinol, etc. Toxic properties are associated with a narcotic effect on the central nervous system and a local cauterizing effect. Lethal dose - 100 ml.

Symptoms: sharp pain along the esophagus and in the abdomen, vomiting mixed with blood, loose stools, frequent urge to urinate, severe weakness, dizziness. In severe poisoning - psychomotor agitation, delirium, disorientation, convulsions, loss of consciousness. In a deep coma, breathing disturbances such as mechanical asphyxia are possible. Complications: bronchopneumonia, acute nephritis. The development of acute renal failure is possible.

First aid: gastric lavage, saline laxative (not castor oil).

Drink plenty of fluids, mucous decoctions. Activated carbon and ice cubes inside.

Treatment. Gastric lavage through a tube and other measures (see Acids).

Perinephric bilateral blockade with novocaine. In coma - alkalinization of urine. Cardiovascular drugs. B vitamins. For agitation and convulsions - chlorpromazine with barbamyl.

Antifreeze. Used in the production of dyes (chemical paints, pencils), pharmaceuticals, polymers. Enters through the respiratory tract, digestive tract, and skin.

Symptoms: Bluish discoloration of the mucous membranes of the lips, ears, and nails. Severe weakness, dizziness, tinnitus, headache, euphoria with motor excitement, vomiting, shortness of breath. In severe poisoning - impaired consciousness and coma. Acute hepatic-renal failure.

First aid: gastric lavage with activated carbon, vaseline oil, saline laxatives, egg whites, hot drinks. Warming the body.

In case of contact with skin, wash the affected areas with a solution of potassium permanganate (1:1000), water and soap. Hot showers and baths are contraindicated. If breathing is weakened - 40% glucose solution with ascorbic acid, sodium thiosulfate (100 ml of 30% solution) intravenously. Repeated replacement of crop. Forced diuresis (alkalinization of urine and water load). Alcohol and other alcohols are contraindicated. Treatment of acute renal failure. Oxyhepotherapy (oxygen) constantly.

Antifreeze— see Poisoning with alcohol and its substitutes.

Gasoline (kerosene). Toxic properties are associated with narcotic effects on the central nervous system. Poisoning can occur when gasoline vapors enter the respiratory tract or when large areas of the skin are exposed. Toxic dose when taken orally is 20-50 g.

Symptoms. In case of poisoning caused by inhalation of low concentrations of gasoline, phenomena similar to a state of intoxication are observed: mental agitation, dizziness, nausea, vomiting, redness of the skin, rapid pulse, and in more severe cases, fainting with the development of convulsions and fever. When drivers suck gasoline into a hose, it sometimes penetrates the lung, which leads to the development of “gasoline pneumonia”: pain in the side, shortness of breath, cough with rusty sputum, and a sharp increase in temperature quickly appear. There is a distinct smell of gasoline from the mouth. If gasoline gets inside, profuse and repeated vomiting, headache, abdominal pain, and loose stools appear. Sometimes there is an enlarged liver and its pain, yellowing of the sclera.

Treatment. Take the victim to fresh air, inhale oxygen, artificial respiration. If gasoline gets inside, rinse the stomach through a tube, give a laxative, hot milk, and heating pads on the stomach. Antibiotics (2,000,000 units of penicillin and 1 g of streptomycin) intramuscularly, antibiotic inhalation. Cardiovascular drugs (cordiamin, camphor, caffeine). For symptoms of "gasoline pneumonia" - ACTH (40 units daily), ascorbic acid (10 ml of 5% solution) intramuscularly. Alcohol, emetics and adrenaline are contraindicated.

Benzene. The lethal concentration in the blood is 0.9 mg/l.

Rapidly absorbed from the lungs and gastrointestinal tract.

Symptoms: When inhaling benzene vapors - alcohol-like agitation, convulsions, pale face, red mucous membranes, dilated pupils. Dyspnea. Decreased blood pressure, possible bleeding from the nose, gums, uterine bleeding, and paralysis of the respiratory center. Death can occur from respiratory arrest and a drop in cardiac activity. When benzene is taken orally, abdominal pain, vomiting, and liver damage (jaundice, etc.) occur.

Treatment. Remove the victim from the danger zone. Gastric lavage through a tube, vaseline oil orally - 200 ml, saline laxative - 30 g of sodium sulfate (Glauber's salt). Forced diuresis. Blood replacement surgery. 30% sodium thiosulfate solution - 200 ml intravenously. Oxygen inhalation. Symptomatic therapy.

Naphthalene. Lethal dose: for adults - 10 g, for children - 2 g. Poisoning is possible through inhalation of vapors or dust, through penetration through the skin, or into the stomach.

Symptoms: numbness, stuporous state. Dyspeptic disorders, abdominal pain. Kidney damage by the type of excretory nephrosis (protein in the urine, hematuria, cylindruria). Possible damage to the retina.

Treatment. Gastric lavage, saline laxative. Alkalinization of urine. Calcium chloride (10 ml of 10% solution), ascorbic acid (10 ml of 5% solution) intravenously, orally rutin, riboflavin 0.02 g repeatedly. Treatment of acute renal failure.

The following pesticides are distinguished: insecticides (insecticides), weed killers (herbicides), drugs used against aphids (aficides), etc. Pesticides that can cause the death of insects, microorganisms, and plants are not harmless to humans. They exhibit their toxic effects regardless of the route of entry into the body (through the mouth, skin or respiratory organs).

Organophosphorus compounds (OPS) - chlorophos, thiophos, karbofos, dichlorvos, etc. are used as insecticides.

Symptoms of poisoning.

Stage I: psychomotor agitation, miosis (contraction of the pupil to the size of a point), tightness in the chest, shortness of breath, moist rales in the lungs, sweating, increased blood pressure.

Stage II: muscle twitching, convulsions, difficulty breathing, involuntary stool, and frequent urination predominate. Coma.

Stage III: respiratory failure increases until breathing stops completely, paralysis of the muscles of the limbs, and a drop in blood pressure. Violation of heart rhythm and cardiac conduction.

First aid. The victim must be immediately removed or removed from the poisoned atmosphere. Remove contaminated clothing. Wash the skin generously with warm water and soap. Rinse eyes with a 2% warm solution of baking soda. In case of poisoning through the mouth, the victim is given several glasses of water to drink, preferably with baking soda (1 teaspoon per glass of water), then vomiting is induced by irritating the root of the tongue.

This manipulation is repeated 2-3 times, after which another half glass of 2% soda solution is given to drink with the addition of 1 tablespoon of activated carbon. Vomiting can be induced by injection of a 1% apomorphine solution.

Specific therapy is also carried out immediately; it consists of intensive atropinization. In stage 1 poisoning, atropine (2-3 ml 0.1%) is injected under the skin during the day until the mucous membranes are dry. In stage II, atropine is injected into a vein (3 ml in 15-20 ml of glucose solution) repeatedly until bronchorrhea and dry mucous membranes are relieved. In a coma, intubation, suction of mucus from the upper respiratory tract, atropinization for 2-3 days. In stage III, life support is possible only with the help of artificial respiration, atropine drip into a vein (30-50 ml). cholinesterase reactivators. In case of collapse, norepinephrine and other measures. In addition, early administration of antibiotics and oxygen therapy are indicated in the first two stages.

For bronchospastic phenomena, use penicillin atropine aerosol. metacin and novocaine.

Organochlorine compounds (OCCs) - hexachlorane, hexabenzene, DDT, etc. are also used as insecticides. All COS are highly soluble in fats and lipids, so they accumulate in nerve cells and block respiratory enzymes in the cells. Lethal dose of DDT: 10-15 g.

Symptoms. When poison gets on the skin, dermatitis occurs. When inhaled, it causes irritation of the mucous membrane of the nasopharynx, trachea, and bronchi. Nosebleeds, sore throat, cough, wheezing in the lungs, redness and pain in the eyes occur.

Upon admission - dyspeptic disorders, abdominal pain, after a few hours cramps of the calf muscles, unsteadiness of gait, muscle weakness, weakened reflexes. With large doses of poison, a coma may develop.

There may be damage to the liver and kidneys.

Death occurs due to symptoms of acute cardiovascular failure.

First aid is the same for FOS poisoning (see above). After gastric lavage, it is recommended to take the GUM mixture inside: 25 g of tannin, 50 g of activated carbon, 25 g of magnesium oxide (burnt magnesia), stir until the consistency of a paste. After 10-15 minutes, take a saline laxative.

Treatment. Calcium gluconate (10% solution), calcium chloride (10% solution) 10 ml intravenously. Nicotinic acid (3 ml of 1% solution) under the skin again. Vitamin therapy. For convulsions - barbamyl (5 ml of 10% solution) intramuscularly. Forced diuresis (alkalinization and water load). Treatment of acute cardiovascular and acute renal failure. Therapy for hypochloremia: 10-30 ml of 10% sodium chloride solution into a vein.

Arsenic and its compounds. Calcium arsenate, sodium arsenite, Parisian green and other arsenic-containing compounds are used as pesticides for treating seeds and controlling agricultural pests; they are physiologically active and poisonous. The lethal dose when taken orally is 0.06-0.2 g.

Symptoms. After the poison enters the stomach, a gastrointestinal form of poisoning usually develops. After 2-8 hours, vomiting, a metallic taste in the mouth, and severe abdominal pain appear. Vomit is greenish in color, loose, frequent stools resembling rice water. Severe dehydration occurs, accompanied by convulsions. Blood in the urine, jaundice, anemia, acute renal failure. Collapse, coma. Respiratory paralysis. Death can occur within a few hours.

First aid. If it enters the stomach, immediately rinse vigorously with water with a suspension of laxatives - magnesium oxide or sulfate (20 g per 1 liter of water), emetics: support vomiting with warm milk or a mixture of milk with beaten egg whites. After rinsing, inside - freshly prepared “arsenic antidote” (every 10 minutes, 1 teaspoon until vomiting stops) or 2-3 tablespoons of the antidote mixture “GUM: dilute 25 g of tannin, 50 g of activated carbon, 25 in 400 ml of water to the consistency of a paste. g magnesium oxide - burnt magnesia.

As early as possible, intramuscular administration of unithiol or dicaptol, replacement blood transfusion. For severe pain in the intestines - platyphylline, subcutaneous atropine, perinephric blockade with novocaine. Cardiovascular drugs according to indications. Treatment of collapse. Hemodialysis on the first day after poisoning, peritoneal dialysis, forced diuresis. Symptomatic treatment.

In the national economy and in everyday life, various concentrated and weak acids are used: nitric, sulfuric, hydrochloric, acetic, oxalic, hydrofluoric and a number of their mixtures ("aqua regia").

General symptoms. When inhaling strong acid vapors, irritation and burns of the eyes, mucous membranes of the nasopharynx, larynx, nosebleeds, sore throat, and hoarseness due to spasm of the glottis occur. Edema of the larynx and lungs is especially dangerous.

When acids come into contact with the skin, chemical burns occur, the depth and severity of which are determined by the concentration of the acid and the area of ​​the burn.

When acid enters the digestive tract is affected: severe pain in the oral cavity, along the esophagus and stomach. Repeated vomiting mixed with blood, esophageal and gastric bleeding. Significant salivation (excessive salivation), leading to mechanical asphyxia (suffocation) due to the pain of coughing and swelling of the larynx. By the end of the first day, in severe cases, especially in case of poisoning with vinegar essence, yellowness of the skin appears. Urine turns pink to dark brown. The liver is enlarged and painful on palpation. The phenomenon of reactive peritonitis. On days 2-3, abdominal pain increases, and a perforation of the stomach is possible.

Frequent complications are purulent tracheobronchitis and pneumonia, burn asthenia, cachexia, cicatricial narrowing of the esophagus and stomach. Death can occur in the first hours due to symptoms of burn shock.

First aid and treatment. If poisoning occurs from inhalation of vapors, the victim must be removed from the contaminated atmosphere, rinse the throat with water, soda solution (2%) or furatsilin solution (1:5000). Inside - warm milk with soda or alkaline mineral (Borjomi) water, mustard plasters on the larynx area. Rinse your eyes and drop 1-2 drops of a 2% novocaine solution or a 0.5% dicaine solution.

If poisoning occurs when poison is ingested, then immediate gastric lavage is necessary with copious amounts of water through a tube or without a tube. Inside - milk, egg whites, starch, mucous decoctions, magnesium oxide (burnt magnesia) - 1 tablespoon per glass of water, swallow pieces of ice, drink vegetable oil (100 g).

The basic principles of symptomatic treatment after hospitalization are the fight against pain shock. If dark urine appears, injection of sodium bicarbonate into a vein, cardiovascular drugs, novocaine blockade. In cases of significant blood loss, repeated blood transfusions are required. Early use of massive doses of antibiotics, hydrocortisone or ACTH. Vitamin therapy. Hemostatic agents - vikasol intramuscularly, calcium chloride into a vein.

For laryngeal edema, inhalation of penicillin aerosols with ephedrine. If this measure is unsuccessful, tracheotomy is performed.

Fast for 2-3 days, then diet N 1a for up to 1.5 months.

Nitric acid. Symptoms: pain and burns of the lips, oral cavity, pharynx, esophagus, stomach. Yellow coloration of the oral mucosa. Vomiting of yellowish bloody substances. Difficulty swallowing. Abdominal pain and bloating. There is protein and blood in the urine. In severe cases, collapse and loss of consciousness.

First aid: gastric lavage, burnt magnesia or lime water after 5 minutes, 1 tablespoon. Drink plenty of water, ice water, milk (glasses), raw eggs, raw egg whites, fats and oils, mucous infusions.

Boric acid. Symptoms: vomiting and diarrhea. Headache. Skin rashes starting on the face. Decline of cardiac activity, collapse.

First aid: gastric lavage, alkaline drink. In case of decline in cardiac activity, stimulants.

Sulfuric acid. Symptoms: burns of the lips are blackish in color, burns of the mucous membrane are white and brown. Vomit is brown, chocolate-colored. First aid - see Nitric acid.

Hydrochloric acid. Symptoms: burns of the oral mucosa that are blackish in color. First aid - see Nitric acid.

Acetic acid, vinegar essence.

Symptoms: bloody vomiting, grayish-white color of the oral mucosa, smell of vinegar from the mouth.

First aid - see Nitric acid.

Phenols (carbolic acid, lysol, guaiacol). Lethal dose of carbolic acid: 10 g.

Symptoms: dyspepsia, chest pain and abdominal pain, vomiting mixed with blood, loose stools. Mild poisoning is characterized by dizziness, stupor, headache, severe weakness, cyanosis, and increasing shortness of breath. In severe poisoning, a coma quickly develops, which is characterized by constriction of the pupils, respiratory failure such as mechanical asphyxia (aspiration of vomit, retraction of the tongue. The phenomena of narcotic damage to the central nervous system predominate. After 2-3 days, the development of acute renal failure is possible, especially with extensive skin burns with Lysol or a solution of carbolic acid. Dark urine is typical as a result of oxidation in air of the phenol products released with it. Death occurs from respiratory paralysis and a decrease in cardiovascular activity.

First aid. Restoration of impaired breathing - oral toilet, etc. Careful lavage of the stomach through a tube with warm water with the addition of 2 tablespoons of activated carbon or burnt magnesia. Saline laxative. Fats, including castor oil, are contraindicated! If phenol gets on the skin, remove clothing that comes into contact with the poison, wash the skin with olive (vegetable) oil.

Treatment. Unithiol (10 ml of 5% solution) intramuscularly. Sodium thiosulfate (100 ml of 30% solution) drips with glucose into a vein. Bilateral perinephric blockade with novocaine. Vitamin therapy: ascorbic acid (10 ml of 5% solution) intramuscularly. Forced diuresis (alkalinization of urine and water load). Cardiovascular drugs. Antibiotics.

Alkalies are bases that are highly soluble in water, aqueous solutions of which are widely used in industry, medicine, and everyday life. Caustic soda (caustic soda), caustic potassium, ammonia (ammonia), slaked and quicklime, potash, liquid glass (sodium silicate).

Symptoms: burn of the mucous membranes of the lips, mouth, esophagus, stomach. Bloody vomiting and bloody diarrhea. Sharp pain in the mouth, pharynx, esophagus and abdomen. Drooling, swallowing disorders. Intense thirst. Kidney damage, alkaline urine. Convulsions, collapse. Sometimes swelling of the larynx. Death can occur from painful shock, or at a later date from complications (gastric perforation, peritonitis, pneumonia, etc.).

First aid: gastric lavage immediately after poisoning. Drink plenty of weak acid solutions (0.5-1% solution of acetic or citric acid), orange or lemon juice, milk, mucous liquids, oil emulsions. Swallow pieces of ice, ice on the stomach. For severe pain, subcutaneous morphine and other painkillers. Urgent hospitalization: treatment is symptomatic.

Barium. Used in vacuum technology, in alloys (printing, bearing). Barium salts - in the production of paints, glasses, enamels, medicine.

All soluble barium salts are toxic. Insoluble barium sulfate used in radiology is practically non-toxic. The lethal dose of barium chloride when taken orally is 0.8-0.9 g, barium carbonate is 2-4 g.

Symptoms. When poisonous barium salts are ingested, a burning sensation in the mouth, pain in the stomach, salivation, nausea, vomiting, loose stools, and dizziness occur. The skin is pale, covered with cold sweat, after 2-3 hours severe muscle weakness occurs (flaccid paralysis of the muscles of the upper limbs and neck). The pulse is slow, weak, there are heart rhythm disturbances, and a drop in blood pressure. Shortness of breath, cyanosis of the mucous membranes.

Treatment: gastric lavage, laxatives, siphon enemas. Symptomatic therapy.

Copper and its compounds (copper oxide, copper sulfate, Bordeaux mixture, copper carbonate, etc.) Lethal dose of copper sulfate 10 ml.

Symptoms. Copper taste in the mouth, vomiting blue-green masses, bloody diarrhea, severe thirst, sharp pain in the abdomen. Headache, weakness, dizziness, difficulty breathing, convulsions, collapse.

Decreased urine, it is black, there is a lot of protein. Acute renal failure (anuria, uremia). Hypochromic anemia is common. Complications: nephritis, enterocolitis. When copper compounds enter the upper respiratory tract, the phenomena of “acute foundry fever” develop: chills, dry cough, temperature up to 40 ° C, headache, weakness, shortness of breath, allergic phenomena - a small red rash on the skin and itching.

First aid. If it enters the stomach, vomiting is caused, then repeated gastric lavages are carried out, preferably with a 0.1% solution of yellow blood salt, the same solution is given orally, 1-3 tablespoons every 15 minutes. Prescribe 1 tablespoon of activated carbon per glass of warm water, a saline laxative, plenty of fluids, protein water, egg whites. Do not give fats (butter, milk, castor oil). For abdominal pain - heat (a heating pad) and injections of a 0.1% solution of atropine sulfate subcutaneously. Inside - complexons such as unithiol, disodium salt EDTA, BAL. For “copper fever” - drink plenty of fluids, diaphoretics and diuretics, as well as antipyretics and bromides. Antibiotics, vitamin therapy, treatment of renal failure and other symptomatic treatment.

Mercury and its compounds (sublimate, calomel, cinnabar, etc.). Metallic mercury is slightly toxic when ingested. The lethal dose of mercuric chloride when taken orally is 0.5 g, which is the most toxic of the inorganic mercury salts, and of the organic ones - novorit, promeran, mercuzal.

Symptoms. When the poison enters the gastrointestinal tract, it has a cauterizing effect on the tissue: sharp pain in the abdomen along the esophagus, vomiting, and after a few hours, loose stools with blood. Copper-red coloration of the mucous membrane of the mouth and pharynx. Swelling of the lymph nodes, metallic taste in the mouth, salivation, bleeding gums, later a dark border of sulfurous mercury on the gums and lips. From 2-3 days, symptoms of damage to the central nervous system appear - excitability, cramps of the calf muscles, epileptiform seizures, confusion. Ulcerative colitis is characteristic. During this period, states of shock and collapse occur.

First aid: the simplest antidotes - magnesium oxide (burnt magnesia), raw eggs in milk, protein water, warm milk in large quantities, mucous decoctions, laxative. Gastric lavage is carried out with the addition of activated carbon and subsequent administration of 80-100 ml of Strzhizhevsky's antidote (a solution of magnesium sulfate, sodium bicarbonate and sodium hydroxide in a supersaturated solution of hydrogen sulfide). After 5-10 minutes, the stomach is washed again with 3-5 liters of warm water mixed with 50 g of activated carbon. As an antidote, use a 5% solution of unithiol in warm water, which is administered in an amount of 15 ml through a probe. After 10-15 minutes, the stomach is washed again with a unithiol solution (20-40 ml of a 5% unithiol solution per 1 liter of water) and the initial dose is given orally again. At the same time, high siphon enemas with warm water and 50 g of activated carbon are given.

In the absence of unithiol, neutralization of the poison is carried out using dicaptol 1 ml intramuscularly (on the 1st day - 4-6 times, from the 2nd day - 3 times a day, from the 5th - 1 time), 30% sodium thiosulfate solution (50 ml intravenous drip). Antishock therapy, infusion resuscitation, and the fight against acute renal failure are indicated.

Lead and its compounds. Used for the manufacture of plates for batteries, electrical cable sheaths, protection against gamma radiation, as a component of printing and antifriction alloys, semiconductor materials, and paints. Lethal dose of white lead: 50 g.

Symptoms: Acute intoxication is characterized by gray discoloration of the gum mucosa and a metallic taste in the mouth. Dyspeptic disorders are noted. Characterized by sharp cramping pain in the abdomen and constipation. Increased blood pressure. Persistent headaches, insomnia, and, in especially severe cases, epileptiform convulsions and acute cardiovascular failure are noted. The chronic course of the disease is more common. Phenomena of toxic hepatitis occur, accompanied by severe impairment of liver function.

First aid: gastric lavage with a 0.5-1% solution of Glauber's salt or Epsom salt. Inside - Epsom salts as a laxative. Drink plenty of protein water, milk, mucous decoctions. For lead colic, warm baths, a heating pad on the stomach, hot drinks, hot enemas with magnesium sulfate (Epsom salts). Subcutaneously - 1 ml of 0.1% atropine solution, intravenously - glucose solution with ascorbic acid, 10% sodium bromide solution, 10 ml each with 0.5% novocaine solution. The specific treatment is EDTA, thetacine-calcium, complexones. Unithiol is ineffective.

Zinc and its compounds (oxide, chloride, sulfate, etc.). They are widely used in electroplating, printing, medicine, etc. They enter the body through the respiratory system, digestive tract, and rarely through the skin.

Symptoms. When the respiratory system is exposed to zinc vapors or particles, “foundry” fever occurs: a sweetish taste in the mouth, thirst, fatigue, weakness, nausea and vomiting, chest pain, redness of the conjunctiva and pharynx, dry cough. After 2-3 hours there is severe chills, the temperature rises to 38-40°C, after a few hours it drops sharply, accompanied by heavy sweat. In severe cases, pneumonia and pulmonary edema may develop.

If zinc compounds enter through the mouth, there is a burn to the mucous membrane of the mouth and digestive tract: severe abdominal pain, persistent vomiting mixed with blood, cramps of the calf muscles, signs of renal failure. Collapse.

First aid. For "foundry" fever - alkaline inhalations, plenty of fluids, rest, warmth and oxygen. Intravenous 20 ml of 40% glucose solution with ascorbic acid (5 ml of 5% solution), EDTA preparation.

In case of poisoning through the mouth - gastric lavage, orally - 1% solution of sodium bicarbonate (soda), activated charcoal, saline laxative, milk, mucous decoctions. Intravenously - glucose with ascorbic acid, intramuscularly - unithiol.

These include a large group of chemical compounds - derivatives of hydrocyanic acid. There are inorganic cyanides (hydrocyanic acid, sodium and potassium cyanides, cyanogen chloride, cyanogen bromide, etc.) and organic cyanides (esters of cyanacetic and cyanoacetic acids, nitriles, etc.). They are widely used in industry, including pharmaceuticals, agriculture, photography, etc. Cyanide enters the body through the respiratory system, digestion, and rarely through the skin.

Symptoms: difficulty breathing, slow breathing. Smell of bitter almonds from the mouth.

Scratching in the throat, tightness in the chest. Dizziness, convulsions, loss of consciousness.

The mucous membranes and skin are bright red.

In severe poisoning, sudden death.

When exposed to smaller doses, a sharp headache, nausea, vomiting, and abdominal pain occur (especially in case of poisoning with potassium cyanide, which has a cauterizing effect on the mucous membranes). There is an increase in general weakness, severe shortness of breath, palpitations, psychomotor agitation, convulsions, and loss of consciousness. Death can occur within a few hours due to symptoms of acute cardiovascular failure and respiratory arrest.

First aid. If the respiratory system is exposed to poison, the victim must be immediately removed from the contaminated area. Quickly remove contaminated clothing and create conditions of rest and warmth; the victim is allowed to inhale amyl nitrite from an ampoule on a cotton swab every 2-3 minutes. Intravenously (urgently!) Inject 10 ml of a 2% sodium nitrite solution, then 50 ml of a 1% solution of methylene blue in a 25% glucose solution and 30-50 ml of a 30% sodium thiosulfate solution. After an hour, the infusion is repeated.

If poison gets inside, lavage the stomach extensively with a 0.1% solution of potassium permanganate or a 2% solution of hydrogen peroxide, or a 2% solution of baking soda, or a 5% solution of sodium thiosulfate. Saline laxative, plenty of warm sweet drinks, emetics. Antidote therapy described above, symptomatic treatment,

In industrial conditions, gaseous chemical substances are widespread - nitrogen oxides, ammonia, bromine vapor, hydrogen fluoride, chlorine, sulfur dioxide, phosgene, etc. These substances at a certain concentration cause irritation of the respiratory tract, therefore they are classified as “irritants”, and Since they can cause oxygen deficiency, they are also called “suffocating”.

General symptoms. The main clinical manifestations of acute poisoning are toxic laryngotracheitis, pneumonia, pulmonary edema. Regardless of what toxic substance we are talking about, the complaints of victims are basically the same: shortness of breath, leading to suffocation, a painful, painful cough, initially dry, and then with the release of mucopurulent or foamy sputum, often stained with blood. General weakness, headache. Increasing pulmonary edema is characterized by pronounced cyanosis of the mucous membranes and skin (blue lips, ears and fingers), difficult, sharply rapid breathing, and an abundance of dry and moist wheezing in the lungs.

First aid. The victim must be provided with complete rest, warmth, and oxygen therapy. Intravenously - 20 ml of 40% glucose solution, 10 ml of 10% calcium chloride solution, 1 ml of cordiamine. If there is an obstruction in the airway, it is necessary to suck out the mucus from the throat, remove the tongue with a tongue holder and insert an airway. Periodically change the patient's position in bed, subcutaneously - 1 ml of 0.1% atropine solution.

In the absence of breathing, artificial respiration is performed using the mouth-to-mouth method, followed by transfer to mechanical respiration. Urgent tracheotomy is performed in case of suffocation resulting from burns of the upper respiratory tract and swelling of the larynx. For pulmonary edema - inhalation of aerosols with diphenhydramine, ephedrine, novocaine. Intravenously - prednisolone, urea, Lasix, cardiovascular drugs as indicated.

Nitrogen. Acute poisoning occurs when working with concentrated nitric acid, in the production of fertilizers, during blasting operations, in all cases where high temperatures are generated (welding, explosions, lightning), etc.

Symptoms: shortness of breath, vomiting, dizziness, intoxication, loss of consciousness and deep coma. Death can occur in the first hours after poisoning.

First aid. It should be carried out in a state of complete rest of the patient according to the principles described above (rest, warmth, continuous inhalation of oxygen). To reduce a painful cough - codeine or dionine. Intravenously - 1 ml of 10% calcium gluconate solution. Banks on the back.

Ammonia. Acute poisoning is possible when cleaning cesspools, sewer pipes, in the production of soda, fertilizers, organic dyes, sugar, etc.

Symptoms. In mild cases of poisoning, irritation of the nasopharynx and eyes, sneezing, dryness and sore throat, hoarseness, cough and chest pain are noted. In more severe cases - burning pain in the throat, a feeling of suffocation, possible swelling of the larynx, lungs, toxic bronchitis, pneumonia.

When concentrated solutions enter the gastrointestinal tract, deep necrosis is formed, which in the acute stage leads to painful shock. Massive esophageal-gastric bleeding, asphyxia as a result of burns and laryngeal edema, severe burn disease, reactive peritonitis. At a later stage, narrowing of the esophagus, antrum and pylorus of the stomach develops. Death can occur in the first hours and days from painful shock, and at a later date - from burn disease and associated complications (massive bleeding, aspiration pneumonia, perforation of the esophagus and stomach, mediastinitis).

First aid. Remove the victim from the toxic environment and rinse the affected areas of the skin and mucous membranes of the eyes with plenty of water. Drink warm milk with Borjomi or soda. Silent mode. For spasm of the glottis and swelling of the larynx - mustard plasters and a warm compress on the neck, hot foot baths. Inhalation of citric or acetic acid steam, oil inhalation and inhalation with antibiotics. Instill 30% sodium sulfacyl solution, 12% novocaine solution or 0.5% dicaine solution into the eyes every 2 hours. In the nose - vasoconstrictors (3% ephedrine solution). Orally - codeine (0.015 g), dionine (0.01 g). Intravenously or subcutaneously - morphine, atropine, for suffocation - tracheotomy.

Bromine. Acute poisoning with bromine vapors is possible in the chemical, photography, film and leather industries, in the production of a number of dyes, etc.

Symptoms: when inhaling bromine vapors, runny nose, lacrimation, drooling, and conjunctivitis occur. The tongue, oral mucosa and conjunctiva are characteristically brown in color. Sometimes significant nosebleeds and allergic phenomena (rash, urticaria, etc.) appear. Acute bronchitis and pneumonia, possible pulmonary edema.
First aid. Remove the victim from the poisoned area. Remove clothes and wash affected areas of skin with alcohol. Inhaling oxygen. Inhalations are alkaline and with 2% sodium thiosulfate solution. Drink warm milk with Borjom or soda. Orally with food, 10-20 g per day of sodium chloride (table salt). Intravenous 10 ml of 10% calcium chloride. Orally - diphenhydramine, pipolfen - 0.025 g each. Cardiac medications.
Sulphur dioxide. Acute poisoning is possible in the production of sulfuric acid, in the metallurgical industry, food industry, oil refining, etc.
Symptoms: runny nose, cough, hoarseness, sore throat. Inhalation of higher concentrations of sulfur dioxide may result in suffocation, speech impairment, difficulty swallowing, vomiting, and possible acute pulmonary edema.
First aid - see Nitrogen.
Hydrogen sulfide. Acute poisoning is possible in the production of carbon disulfide, in the leather industry, in mud baths, in coke plants and oil refineries. Hydrogen sulfide is found in wastewater and sewer gases. Lethal concentration in air: 1.2 mg/l.
Symptoms: runny nose, cough, pain in the eyes, headache, nausea, vomiting, agitation. In severe cases - coma, convulsions, toxic pulmonary edema.
First aid. Remove the victim from the poisoned atmosphere. Rinse your eyes with warm water, drip sterile vaseline oil (2-3 drops), for severe pain - 0.5% dicaine solution. Rinse the nasopharynx with a 2% solution of baking soda. When coughing, take codeine (0.015 g) inside. If breathing and cardiac activity stop, indirect cardiac massage and artificial respiration (see Chapter 1 Internal Diseases, Section 2, Sudden Death). Treatment of pulmonary edema (see above).
Carbon monoxide, illuminating monoxide (carbon monoxide). Poisoning is possible in production, where carbon monoxide is used for the synthesis of a number of organic substances (acetone, methyl alcohol, phenol, etc.), in garages with poor ventilation, in unventilated newly painted rooms, as well as at home when there is a leak of lighting gas and when stove dampers are untimely closed in rooms with stove heating (houses, baths).
Symptoms: loss of consciousness, convulsions, dilated pupils, severe cyanosis (blue discoloration) of the mucous membranes and facial skin.
Death usually occurs at the scene as a result of respiratory arrest and a drop in cardiac activity. With a lower concentration of carbon monoxide, headache, pounding in the temples, dizziness, chest pain, dry cough, lacrimation, nausea, and vomiting appear. Visual and auditory hallucinations are possible. Redness of the skin, carmine red coloring of the mucous membranes, tachycardia, and increased blood pressure are noted. Subsequently, drowsiness develops, motor paralysis is possible with preserved consciousness, then loss of consciousness and a coma with severe clonic-tonic convulsions, involuntary passage of urine and feces. The pupils are sharply dilated with a weakened reaction to light. Breathing disturbance increases, which becomes continuous, sometimes of the Cheyne-Stokes type. When emerging from a comatose state, a sharp motor excitation is characteristic. Coma may develop again. Severe complications are often observed: cerebrovascular accident, subarachnoid hemorrhage, polyneuritis, cerebral edema, visual impairment. The development of myocardial infarction is possible. Skin-trophic disorders (bubbles, local edema with swelling and subsequent necrosis), myoglobinuric nephrosis are often observed. With a long coma, severe pneumonia is constantly observed.

First aid. First of all, immediately remove the poisoned person from this room; in the warm season it is better to take him outside. If shallow breathing is weak or stops, begin artificial respiration (see Chapter 1, Internal Medicine, Section 2, Sudden Death). Rubbing the body, heating pads on the feet, and briefly inhaling ammonia can help eliminate the consequences of poisoning. Patients with severe poisoning are subject to hospitalization, as complications from the lungs and nervous system are possible at a later date.

It is necessary to firmly know that since the leading factor in the development of poisoning is a lack of oxygen due to the entry of carbon monoxide into the body, the main attention should be paid to oxygen therapy, preferably under high pressure. Therefore, if poisoning occurred near the oxygen barotherapy center. Every effort should be made to ensure that the patient is delivered to such a medical institution in the first hours after poisoning. To relieve seizures and psychomotor agitation, you can use neuroleptics, for example, aminazine (1-3 ml of a 2.5% solution intramuscularly, previously diluted in 5 ml of a 0.5% sterile solution of novocaine) or chloral hydrate in an enema. Bemegride, corazol, analeptic mixture, camphor, caffeine are contraindicated for these phenomena. If breathing is impaired - 10 ml of 2.4% aminophylline solution into a vein again. In case of severe cyanosis (blue discoloration) in the 1st hour after poisoning, intravenous administration of a 5% solution of ascorbic acid (20-30 ml) with glucose is indicated. Intravenous infusion of 5% glucose solution (500 ml) with 2% novocaine solution (50 ml), 40% glucose solution into a vein drip (200 ml) with 10 units of insulin under the skin.

Fluorine. Sodium fluoride (part of enamels, used for preserving wood). Hydrogen fluoride, hydrofluoric acid, fluorine-containing salts. Lethal dose: 10 g sodium fluoride.

Symptoms: abdominal pain occurs, lacrimation, salivation (excessive production of saliva), severe weakness, vomiting, loose stools develop. Breathing becomes more frequent, muscle twitching and convulsions appear, and pupils constrict. The pulse is increased, blood pressure is reduced, and atrial fibrillation is possible. Death occurs due to symptoms of general cardiovascular failure. Sometimes kidney damage occurs.

First aid. Under the action of fluorine and hydrogen fluoride - see Bromine. For hydrofluoric acid poisoning, see Acids. In case of poisoning with fluoride-containing salts - gastric lavage through a tube, preferably with lime water or 1% calcium chloride solution, saline laxative. Atropine (1 ml of 0.1% solution) under the skin repeatedly, cardiovascular drugs. Diphenhydramine (2 ml of 1% solution) subcutaneously. Calcium chloride or calcium gluconate (10 ml of 10% solution) into a vein again. To combat dehydration of the body - intravenous drip administration of saline and glucose solution up to 3000 ml per day. Treatment of collapse. Vitamin therapy: vitamins B1 (3 ml of 5% solution) into a vein again, Bb (2 ml of 5% solution), B 12 (up to 500 mcg). Treatment of kidney failure.

Chlorine. Inhalation of concentrated vapors can lead to rapid death as a result of chemical burns and reflex inhibition of the respiratory center. In less severe cases, pain in the eyes, lacrimation, painful paroxysmal cough, chest pain, headache, and dyspeptic disorders appear. A lot of dry and moist rales are heard, symptoms of acute pulmonary emphysema, severe shortness of breath and cyanosis of the mucous membranes develop. Severe bronchopneumonia with a rise in temperature and the development of toxic pulmonary edema is possible. In case of minor poisoning, the phenomena of acute laryngitis, tracheitis, tracheobronchitis predominate. A feeling of tightness in the chest, dry cough, dry wheezing in the lungs.

First aid - see Nitrogen.

Diseases that arise as a result of eating poor quality food - see in detail Botulism, Food Toxic Infections, Ch. Infectious diseases.

Symptoms: vomiting, diarrhea, abdominal pain. Dizziness, headache, general weakness. Pupil dilation. In severe cases - swallowing disorder, ptosis, collapse.

First aid: gastric lavage with a solution of potassium permanganate (0.04%), tannin (0.5%) or water mixed with activated carbon. Internal laxative, cleansing enemas, then disinfectants: salol, methenamine. Drink plenty of fluids: slimy drinks (starch, flour).

It is prohibited to eat any food for 1-2 days. In the acute period (after gastric lavage), hot tea and coffee are indicated. The patient must be warmed by covering him with heating pads (to his legs, arms). Taking sulfonamides (sulgin, phthalazole) 0.5 g 4-6 times a day or antibiotics (for example, chloramphenicol 0.5 g 4-6 times a day) significantly contributes to recovery. The victim should call an ambulance or be taken to a medical facility.

Treatment: saline solution under the skin. In case of decline in cardiac activity - injections of caffeine, camphor, in case of severe pain - painkillers. For botulism - anti-botulism serum.

Pale grebe. Symptoms: after 68 hours and later, uncontrollable vomiting, colicky abdominal pain, and bloody diarrhea occur. On days 2-3, signs of liver and kidney failure, jaundice, enlarged and painful liver, and anuria appear. A comatose state develops. The mortality rate reaches 50%.

Fly agarics. Symptoms: no later than 2 hours later, vomiting, increased sweating, drooling, abdominal pain, sharp constriction of the pupils occurs. In more severe cases of poisoning, severe shortness of breath, bronchorrhea, a decrease in pulse and a drop in blood pressure appear, convulsions and delirium, hallucinations and a coma are possible.

Lines. When cooked well, they are non-toxic. In case of poisoning, vomiting and diarrhea occur. After 6-12 hours, jaundice appears, dark-colored urine due to hemoglobinuria, enlarged and painful liver.

Poisonous russula, russula, etc. The phenomena of acute gastroenteritis as a result of damage to the gastrointestinal tract predominate.

First aid for mushroom poisoning often plays a decisive role in saving the patient. It is necessary to immediately begin gastric lavage with water, preferably using a probe with a weak solution (pink) of potassium permanganate or by artificial vomiting. It is useful to add activated carbon (carbolene) to the solution. Then they give a laxative (castor oil and saline), and give cleansing enemas several times. After this, the patient is warmly covered and covered with heating pads, and given hot sweet tea and coffee to drink. The patient should be taken to a medical facility, where he will be provided with the medical care he needs.

Specific treatment. For red fly agaric poisoning, the antidote is atropine, injections of a 0.1% solution of 1 ml under the skin should be repeated 3-4 times at intervals of 30-40 minutes. To relieve bronchospasm - isadrin (novodrin, euspirin), aminophylline in normal doses. Caffeine is a useful analeptic. Acids and acidic foods, which promote the absorption of the muscarine alkaloid contained in the red fly agaric, are contraindicated.

Treatment for poisoning with panther fly agaric (similar to champignon and edible umbrella) is similar to treatment for poisoning with plants containing atropine and scopolamine (see Henbane).

In case of poisoning with toadstool, as well as false honey fungus, gall fungus, satanic mushroom, milk mushrooms (milk mushrooms, bitter mushrooms, pigweed, volushki), treatment is primarily aimed at eliminating dehydration and collapse. Various plasma expanders are used: Ringer's solution, isotonic sodium chloride solution, saline infusin, polyglucin, etc. in a volume of at least 3-5 liters per day into a vein by drip. They use norepinephrine or mesaton to increase blood pressure, to prevent or reduce liver damage - hydrocortisone or similar drugs, broad-spectrum antibiotics. In case of developed heart failure - strophanthin, korglykon. The prognosis for poisoning with toadstool is very unfavorable. It should be borne in mind that the toxic substances of the toadstool are not afraid of high temperature and drying, do not pass into the decoction and cause degeneration of the kidneys, liver and heart.

Black henbane, datura, belladonna belong to the same nightshade family. The poisonous substance in these plants is considered to be atropine and scopolamine, which block the parasympathetic nerves. The entire plant is considered poisonous. Henbane poisoning is possible either by consuming young sweet sprouts (April-May) or by eating the seeds. Belladonna poisoning is most often associated with consumption of berries similar to wild cherries. Datura poisoning also occurs when eating seeds.

Symptoms. In case of mild poisoning, dry mouth, speech and swallowing disorders, dilated pupils and impaired near vision, photophobia, dryness and redness of the skin, agitation, sometimes delirium and hallucinations, and tachycardia appear. In severe poisoning, complete loss of orientation, sudden motor and mental agitation, sometimes convulsions followed by loss of consciousness and the development of a coma. A sharp increase in body temperature, cyanosis (blue discoloration) of the mucous membranes, shortness of breath with the appearance of periodic breathing of the Cheyne-Stokes type, irregular, weak pulse, drop in blood pressure. Death occurs due to symptoms of paralysis of the respiratory center and vascular insufficiency. A specific complication of atropine poisoning is trophic disorders - significant swelling of the subcutaneous tissue of the face, in the forearms and legs.

First aid.
Gastric lavage followed by administration of 200 ml of vaseline oil or 200 ml of 0.2-0.5% tannin solution through a tube. To relieve acute psychosis - chlorpromazine intramuscularly. At high body temperature - cold on the head, wrapping in damp sheets. More specific means include administering 1-2 ml of a 0.05% proserine solution under the skin.

Stone fruit garden plants. These include the pits of apricot, almond, peach, cherry, and plum, which contain the glycoside amygdalin, which is capable of releasing hydrocyanic acid (hydrogen cyanide) in the intestines. Poisoning is possible either by eating large quantities of seeds contained in the seeds, or by drinking alcoholic beverages prepared with them. Children are more sensitive to the effects of hydrocyanic acid than adults. Sugar weakens the effect of the poison.

Symptoms, first aid, treatment - see Cyanide poisoning.

Poisonous hemlock (hemlock) and hemlock (omega spotted) are very similar to each other, they grow in damp places near water everywhere, and even experts often confuse them.

Vekh poisonous contains in its rhizomes a resin-like substance, cicutoxin. Poisoning is accidental and occurs more often in children.

Symptoms: after a few minutes, vomiting, drooling, and abdominal cramps begin. Then dizziness, unsteady gait, and foam at the mouth appear. The pupils are dilated, convulsions give way to paralysis and death.

Treatment purely symptomatic - gastric lavage with the introduction of sodium sulfate (20-30 g) in half a glass of water and 200 ml of vaseline oil through a tube, to relieve cramps - 1 g of chloral hydrate in an enema with mucus or 5-10 ml of a 5% barbamyl solution intramuscularly. Due to convulsions, the use of analeptics is undesirable; in case of breathing problems, artificial respiration is used. To stimulate cardiac activity - strophanthin or similar drugs.

Hemlock. Poisoning occurs when mistakenly using parsley or horseradish leaves instead, as well as when using its fruits instead of anise fruits.

Symptoms: salivation, nausea, vomiting, diarrhea. The pupils are dilated, the body temperature is low, the limbs are cold, immobilized, breathing is difficult.

Treatment. Gastric lavage, salt laxative, Vaseline oil through a tube. The main focus is the fight against breathing disorders: inhalation of oxygen, apaleptics in normal doses. If breathing stops - artificial, for accelerated removal of poison - osmotic diuretics, furosemide.

Fighter (wolfsbane). Poisoning is possible through self-medication, through accidental use instead of horseradish or celery, as well as through a suicide attempt.

Symptoms: burning sensation in the mouth, salivation, nausea, vomiting, diarrhea. Numbness and discomfort in the tongue, face, fingers, headache, and weakness quickly follow. Hearing and vision are impaired. Loss of consciousness and convulsions. Death from paralysis of the heart and breathing.

Treatment. Gastric lavage with 0.5% tannin, saline laxative, tannin. Mandatory bed rest to keep the patient warm. To prevent heart weakness - strophanthin, atropine in normal doses, analeptics, strong tea or coffee. Anticonvulsant treatment.

Wolf's bast (daphne)- found everywhere. The cause of poisoning is its bright red berries or the bark of branches, which are cut off for the sake of beautiful, lilac-like flowers. Symptoms, treatment. When the plant juice gets on the skin, irritation occurs: pain, redness, swelling, then blisters and ulcers. Treatment is carried out as for burns: lubrication with a solution of dicaine (mucous membranes), bandages with liniment of synthomycin, chloramphenicol or streptocide, Vishnevsky ointment.

In case of poisoning with berries or juice - a burning sensation in the mouth and throat, difficulty swallowing, salivation, stomach pain, diarrhea, vomiting. Blood in urine. Death can occur from cardiac arrest.

Treatment- symptomatic; Gastric lavage followed by administration of Vaseline oil. Laxatives are contraindicated. Therapy is aimed at eliminating irritation of the mucous membranes of the digestive tract (ice pieces inside, lubricating the mucous membranes with dicain, anesthesin - inside), combating acute heart failure (strophanthin and other combined drugs).

Yellow acacia (broom, golden shower) and mouse grass (thermopsis) contain the alkaloid cytisine. Poisoning is possible by eating acacia fruits (pods) and an accidental overdose of infusions of the thermopsis herb, used against cough.

Symptoms: nausea, vomiting, dizziness, weakness, cold sweat. The mucous membranes are pale, then bluish. At the height of poisoning, diarrhea occurs. In severe poisoning - confusion, agitation, hallucinations, convulsions. Death occurs from respiratory arrest or from cardiac weakness.

First aid. Gastric lavage through a tube, saline laxative, tannin through a tube. To combat seizures - chloral hydrate in an enema, barbamyl intramuscularly, with agitation - aminazine intramuscularly, with cardiac weakness - strophanthin. At the beginning of poisoning, atropine is useful (1-3 ml of 0.1% solution under the skin).

Ergot (uterine horns). Contains alkaloids - ergometrine, ergotoxin, as well as acetylcholine, histamine, etc. Lethal: dose about 5 g.

Symptoms. Dyspeptic disorders (vomiting, abdominal pain, diarrhea, thirst), dizziness, dilated pupils, disorientation. There may be delirium, uterine bleeding. Abortion is possible during pregnancy. In severe poisoning - convulsions, acute cardiovascular failure. After poisoning - long-term neurological disorders, endarteritis, trophic ulcers, impaired blood supply to the extremities.

Treatment. Gastric lavage, saline laxative. Sedative therapy: aminazine (2 ml of 1.5% solution), diphenhydramine (2 ml of 1% solution) intramuscularly. Inhalation of amyl nitrite, 5% glucose solution, sodium chloride (up to 3000 ml of isotonic solution) subcutaneously, Lasix - 40 ml intramuscularly. Water load. Cardiovascular drugs. Treatment of acute cardiovascular failure.

Wormseed. Toxic dose: 15-20 g.

Symptoms. When large doses of drugs are ingested, dyspeptic disorders appear - nausea, vomiting, abdominal pain, diarrhea. Possible xanthopsia (yellow vision, yellow-red urine). In severe poisoning, convulsions, loss of consciousness, collapse develop, and possible kidney damage such as toxic necronephrosis.

Treatment. Gastric lavage, saline laxative. Forced diuresis (alkalinization of urine). For convulsions - 3 ml of 10% barbamyl solution into a vein or chloral hydrate in an enema. Calcium gluconate (10 ml of 10% solution) intramuscularly. Vitamin therapy: 5% solution of vitamin B1 - 2 ml. Treatment of cardiovascular failure.

Hellebore is a herbaceous plant. Its rhizome contains the alkaloid veratrine. Its lethal dose: about 0.02 g.

Symptoms. Often the only sign of poisoning is dyspeptic disorders (nausea, vomiting, loose stools) and a sharp slowdown in pulse with a drop in blood pressure.

First aid is similar to previous poisonings. Specific treatment - 0.1% atropine solution up to 2 ml subcutaneously, cardiovascular drugs.

Snake bites. As a rule, snakes do not attack people first and bite people when they are disturbed (touched, stepped on, etc.).

Symptoms and course. In the first minutes, mild pain and a burning sensation occurs, the skin turns red, and swelling increases. The consequences depend on the type of snake, time of year, age and, especially, the location of the bite. A bite to the head and neck is much more severe than to a limb: there is a higher concentration of poison in the blood, which affects the nervous system and can cause death from paralysis of the respiratory center. General symptoms of poisoning: muscle weakness, dizziness, nausea, vomiting, fever, numbness and aching pain in the affected area.

First aid should begin with vigorous suctioning of the venom. It is best to use a medical jar or its substitute (a thin glass, a glass), into the cavity of which a lit wick is inserted and the edges are quickly applied to the wound.

You can suck out poison with your mouth only if there are no cracks in the lips and oral cavity, as well as carious teeth. In this case, it is necessary to constantly spit out the sucked liquid, as well as rinse the mouth. Suction is performed for 15-20 minutes. Then the bite site is treated with iodine and alcohol and the limb is immobilized. The patient is given complete rest, given plenty of fluids, vodka or alcohol is contraindicated (alcohol intoxication is added). It is recommended to use a specific serum in the first 30 minutes: polyvalent (if the type of snake is not established), “anti-viper” (against the bite of all vipers) or “anti-cobra”, “anti-efa”. Immediately after the bite, 10 ml of serum is enough, after 20-30 minutes 2-3 times more, and so on, but not more than 100-120 ml. The serum is injected under the skin, between the shoulder blades, and in severe cases intravenously.

Tourniquets and incisions are harmful, since they do not have time to prevent the absorption of the neurotoxic part of the poison, and the manifestations of necrosis intensify after these measures. As a last resort, you can resort to pricking with a long needle 2-3 times at the site of the bite if the fluid from the wound is poorly sucked out. Novocaine blockade at the site of the bite is needed only in the absence of serum. Novocaine and alcohol weaken the effect of the serum.

The limb must be immobilized with a splint or improvised means, the patient must be kept at rest, and transported only while lying down. Hot, strong tea or coffee should be given in large quantities. It is necessary to administer heparin (5000-10000 units subcutaneously or into a vein), antiallergic treatment - hydrocortisone acetate suspension 150-200 mg per day intramuscularly or similar drugs (prednisolone, etc.) in equivalent doses, 30% sodium thiosulfate solution, 10% calcium chloride solution 5-20 ml into a vein. In case of cardiac dysfunction - caffeine (camphor, cordiamine, etc.), strophanthin, norepinephrine, mesatone in the usual way.

Insect bites (bees, wasps, bumblebees, hornets), as well as the introduction of toxic doses of bee venom medications (venapioline, toxapine, virapine). The toxic effect depends on the histamine contained in the poison and other potent enzymes.

Symptoms. At the site of the bite - pain, burning, swelling, local increase in temperature. With multiple bites - weakness, dizziness, headache, chills, nausea, vomiting, increased body temperature. With increased sensitivity to poison - urticaria, palpitations, pain in the lower back and joints, convulsions and loss of consciousness. An attack of bronchial asthma or anaphylactic shock is possible.

First aid. Remove the sting with tweezers, apply ice to the affected area, and prednisolone ointment. Rest, warming the extremities, plenty of hot drinks, amidopyrine (0.25 g each), analgin (0.5 g each), cardiac medications, antihistamines, antiallergic drugs (diphenhydramine 0.025-0.05 g orally). Injections of 2 ml of 0.5% novocaine solution and 0.3 ml of 0.1% adrenaline solution into the bite site. Treatment of anaphylactic shock with such. Forced diuresis.

In severe cases - calcium chloride (10 ml of 10% solution) intravenously, prednisolone 0.005 g orally or hydrocortisone intramuscularly.

Stings in the oral cavity are dangerous, which happens when eating fruit, jam, when an insect enters the mouth with food. In such cases, death can occur very quickly not from general intoxication, but from swelling of the larynx and suffocation - an urgent tracheotomy is necessary.

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

Poisoning should be suspected in cases where a completely healthy person suddenly feels unwell immediately or a short time after eating or drinking, taking medication, as well as cleaning clothes, dishes and plumbing with various chemicals, treating the room with substances that kill insects or rodents, etc. P. Suddenly, general weakness may appear, even to the point of loss of consciousness, vomiting, convulsions, shortness of breath, and the skin of the face may suddenly turn pale or blue. The suspicion of poisoning is strengthened if one of the described symptoms or a combination of them appears in a group of people after eating or working together.

The causes of poisoning can be: medicines, food products, household chemicals, plant and animal poisons. A toxic substance can enter the body in various ways: through the gastrointestinal tract, respiratory tract, skin, conjunctiva, or when the poison is injected (subcutaneously, intramuscularly, intravenously). The damage caused by the poison can be limited only to the place of first direct contact with the body (local effect), which is very rare. Most often, the poison is absorbed and has a general effect on the body (resorptive), manifested by primary damage to individual organs and systems of the body.

General principles of first aid for poisoning

1. Call an ambulance.

2. Resuscitation measures.

3. Measures to remove unabsorbed poison from the body.

4. Methods for accelerating the elimination of already absorbed poison.

5. Use of specific antidotes (antidotes).

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

2. Resuscitation measures are necessary in case of cardiac and respiratory arrest. They begin only if there is no pulse in the carotid artery, and after removing vomit from the oral cavity. These measures include artificial ventilation (ALV) and chest compressions. But this is not possible for all poisonings. There are poisons that are released with exhaled air (FOS, chlorinated hydrocarbons) from the respiratory tract of the victim, so those performing resuscitation can be poisoned by them.

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

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

If poison gets on the conjunctiva, it is best to rinse the eye with clean water or milk so that the rinsing water from the affected eye does not enter the healthy eye.

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

B) If poison enters through the mouth, it is necessary to urgently call an ambulance, and only if this is impossible, or if it is delayed, only then can one begin to lavage the stomach with water without using a probe. The victim is given several glasses of warm water to drink and then vomiting is induced by irritating the root of the tongue and pharynx with a finger or spoon. The total volume of water should be large enough, at home - at least 3 liters, when washing the stomach with a tube, use at least 10 liters.

It is better to use only clean warm water to rinse the stomach.

Probeless 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 waters repeatedly comes into contact with the affected areas of the mucous membrane of the oral cavity and esophagus, and this leads to more severe burns of these organs. It is especially dangerous to perform gastric lavage without a tube in young children, since there is a high probability of aspiration (inhalation) of vomit or water into the respiratory tract, which will cause suffocation.

It is prohibited: 1) to induce vomiting in an unconscious person; 2) induce vomiting in case of poisoning with strong acids, alkalis, as well as kerosene, turpentine, since these substances can cause additional burns of the pharynx; 3) rinse the stomach with an alkali solution (baking soda) in case of acid poisoning. This is due to the fact that the interaction of acids and alkalis releases gas, which, accumulating in the stomach, can cause perforation of the stomach wall or painful shock.

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

A very good effect is obtained by introducing activated carbon 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 a 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 remains in the stomach or intestines for a long time, a toxic substance can be released from the microscopic pores of activated carbon and begin to be absorbed into the blood. Therefore, after taking activated carbon, it is necessary to administer a laxative. Sometimes, when providing first aid, activated carbon is given before gastric lavage, and then after this procedure.

Despite gastric lavage, some of the poison may 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 liquid for colon lavage is clean water.

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

5. Antidotes are used by emergency medical personnel or the toxicology department of a hospital only after determining the poison that poisoned the victim

Children get poisoned mostly at home; all adults should remember this!

More on the topic First aid for acute poisoning:

1. LESSON 10 First aid for acute poisoning. The concept of “foodborne toxic infections”. First aid for vomiting, hiccups, diarrhea, constipation. Botulism clinic.

Basic principles of first aid for poisoning(at the first aid stage) :

1. Stop, and if possible immediately, further exposure of the victim to the toxic agent.
2. Remove the toxic substance from the body.
3. Maintaining the basic vital functions of the body (central nervous and cardiovascular systems, respiratory organs) until the arrival of medical workers.

First aid for inhalation poisoning (general requirements):

1. Remove or remove the victim from the poisoned atmosphere to a warm, ventilated, clean room or fresh air.
2. Call emergency medical assistance.
3. Remove clothing that makes breathing difficult.
4. Remove clothing that absorbs harmful gas or is contaminated with a toxic substance.
5. If a toxic substance gets on your skin, wash the contaminated area thoroughly with warm water and soap.
6. In case of irritation of the mucous membranes of the eyes and upper respiratory tract (lacrimation, sneezing, nasal discharge, cough):
rinse eyes with warm water or 2% soda solution;
rinse your throat with a 2% soda solution;
If you have photophobia, wear dark glasses.
7. Warm the victim (using heating blankets).
8. Create physical and mental peace.
9. Give the victim a position that makes breathing easier - half-sitting.
10. During coughing attacks, drink warm milk with Borjomi mineral water or soda in small sips.
11. In case of loss of consciousness, ensure airway patency (prevent suffocation with the root of the tongue or vomit).
12. If breathing stops, start artificial ventilation (ALV).
13. When pulmonary edema begins:
apply venous tourniquets to the arms and legs;
make hot foot baths (place your feet up to the middle of the shin in a container of hot water).
14. Ensure constant monitoring of the victim’s condition until medical workers arrive.

First aid for carbon monoxide poisoning:

1. Take the victim to fresh air.
2. Loosen clothing that restricts breathing.
3. If breathing stops, perform artificial respiration.
4. If there is no pulse in the carotid artery, perform an indirect cardiac massage.
5. In case of simultaneous cessation of breathing and blood circulation (heartbeat), carry out cardiopulmonary resuscitation measures.
6. Urgently deliver the victim to a medical facility by transport.

First aid for food poisoning (toxic infection):

1. Rinse the stomach, give the victim plenty of fluids and induce a gag reflex.
2. Take activated charcoal orally at the rate of 1 gram per kilogram of the victim’s weight or 1 tablespoon of enterodesis dissolved in water (a small amount).
3. Give a laxative to drink (for example, castor oil, 30 grams for an adult).
4. Give plenty of fluids.
5. Cover warmly and give hot sweet tea/coffee.
6. In severe cases, urgently transport the victim to a medical facility.

Transport the victim in a sitting or lying position, depending on his condition.
Technique of tubeless gastric lavage:
1) drink fractionally (in several doses) 6-10 glasses of a warm, weak solution of sodium bicarbonate (dissolve 2 teaspoons of baking soda in 1 liter of water) or warm water, slightly tinted with potassium permanganate (potassium permanganate);
2) induce vomiting (press the root of the tongue with two fingers and induce a gag reflex);
3) empty the stomach of its contents (to clean rinsing water);
4) give hot strong tea to drink, a caffeine tablet - 0.1 g, 20 drops of cordiamine solution.
Before and after gastric lavage, you can use activated charcoal in the form of a paste.
It is prohibited to use the tubeless method of gastric lavage in case of poisoning with aggressive substances (acids and alkalis) !

Attention ! Removal of chemicals from the stomach is carried out only with the help of a tube and only by medical professionals.