How does carbon monoxide poisoning manifest? What to do if you have carbon monoxide poisoning

is a pathological condition that occurs when inhaling carbon monoxide-laden air or smoke. The clinical picture is dominated by disturbances in the central nervous system, respiratory and cardiovascular failure. A characteristic sign of poisoning is pronounced hyperemia of the skin. The diagnosis is established on the basis of anamnesis, clinical manifestations, and determination of blood carboxyhemoglobin levels. Oxygen therapy and detoxification measures are provided as emergency assistance. Next, symptomatic conservative treatment is carried out.

Prognosis and prevention

The prognosis depends on the severity of the pathological process, timeliness and quality medical care. Mild poisoning is relieved without consequences, moderate and severe poisoning often leads to complications from the central nervous and cardiovascular systems. It is not possible to predict the recovery of a patient in a coma. A poor prognostic sign is the worsening of neurological symptoms during the first 48 hours during intensive treatment.

For preventive purposes, it is necessary to follow fire safety rules. To avoid household and industrial poisoning, you should not use faulty gas and stove equipment and electrical appliances. It is not recommended to be in the garage while the car engine is running. Production premises must be well ventilated.

In our article we will examine the question of what to do in case of carbon monoxide poisoning? Not only his future health, but also whether he will remain alive often depends on how correctly and quickly first aid is provided to the victim.

What is carbon monoxide?

“The silent killer” is what people call carbon monoxide. This is one of the most powerful poisons, capable of killing a living creature in just a few minutes. Chemical formula of this gaseous compound is CO (one carbon atom and one oxygen atom). Another name for carbon monoxide is carbon monoxide. This air mixture has neither color nor odor.

CO is formed from any type of combustion: from the combustion of fuel at thermal and power plants, from the burning of a fire or gas stove, from the operation of an internal combustion engine, from the smoldering fire of a cigarette, etc.

The toxic properties of carbon monoxide have been known to mankind since ancient times. Our distant ancestors were well aware of how dangerous it is to turn off the stove draft when the wood is not completely burned out. Wanting to retain more heat, the unreasonable owner was in a hurry to close the damper, the whole family went to bed, and did not wake up the next morning.

With the development of civilization, the danger associated with carbon monoxide has not decreased. After all, now instead of stoves in the homes of modern people, gas boilers and stoves are actively working, cars are puffing with toxic fumes on the streets and in garages, and reports periodically appear in the news about tragic accidents associated with CO poisoning.

How does carbon monoxide affect the human body?

Carbon monoxide has the ability to bind hemoglobin molecules, thereby preventing the blood from carrying oxygen. The longer a person breathes toxic air that contains carbon monoxide, the faster it develops. pathological process. The substance carboxyhemoglobin is formed in the blood. The cells of the body do not receive life-giving oxygen, a headache appears, the person begins to experience suffocation, and the consciousness is confused. The victim does not realize what is happening to him, in this case, self-providing first aid for carbon monoxide poisoning becomes impossible. Help must come from other people.

It takes quite a long time for hemoglobin to be completely cleared of carbon monoxide. The danger to life is directly related to the increase in CO concentration in the air and the concentration of carboxyhemoglobin in the blood. If carbon monoxide builds up in air environment is only 0.02-0.03%, then after 5-6 hours the content of carboxyhemoglobin in human blood will be 25-30%.

Rescue actions in case of carbon monoxide poisoning must be very fast, because if the CO concentration reaches only 0.5%, carboxyhemoglobin will increase to lethal values within 20-30 minutes.

What are the symptoms of carbon monoxide poisoning?

The toxic effects of CO on the body can be manifested by the following symptoms:

If a person is poisoned by carbon monoxide in mild degree he may feel weakness, tinnitus, headache, nausea, and the urge to vomit. These signals are evidence of oxygen starvation that the brain experiences.
In case of moderate poisoning, the symptoms of intoxication increase. Tremors in the muscles, short-term memory loss, and loss of coordination of movements appear. A person may cease to distinguish colors, objects begin to appear in two in the eyes. Later broken respiratory function and the functioning of the circulatory system. The victim develops tachycardia and cardiac arrhythmia. If a person does not receive at this stage quick help, then loss of consciousness and subsequent death occurs.
Severe CO poisoning is accompanied by irreversible damage to brain cells. The victim may fall into coma and stay there for a week or more. At this time, the patient experiences severe convulsive seizures, uncontrolled urination and defecation. Breathing is usually shallow and intermittent, body temperature rises to 38-39 degrees. Respiratory paralysis and death may occur. The survival prognosis depends on the depth and duration of the coma.

When can CO poisoning occur?

With normal ventilation and a well-functioning exhaust hood, carbon monoxide is quickly removed from the room without causing any harm to the people there. However, according to statistics, more than one and a half million people die from carbon monoxide poisoning in the world every year. In some cases, this happens for reasons beyond a person’s control, for example, during a fire. Usually, people caught in a fire lose consciousness, inhaling the deadly gas, and cannot get out of the fire trap themselves.

CO poisoning is also possible when following cases and circumstances:

In rooms with stove or fireplace heating (residential buildings, bathhouses, etc.) in case of untimely closing of the exhaust dampers or poor exhaust.
In rooms where gas appliances operate (water-flowing heaters, stoves, gas boilers, heat generators with an open combustion chamber); if there is insufficient air flow necessary for gas combustion, as well as if the draft in the chimney is impaired.
In production workshops where CO is used as a working substance for the synthesis of certain organic matter(phenol, methyl alcohol, acetone, etc.).
If you spend a long time next to a busy highway or directly on it (on most large highways, CO levels in the air can exceed the permissible standards several times).
In garages, with the car engine running and no ventilation.

Carbon monoxide poisoning - first aid

It is important to act very quickly, remembering that the countdown is not just minutes, but even seconds. What should you do first in case of carbon monoxide poisoning? The sequence of actions should be as follows:

Quickly open all windows and doors and carry the person out of the room.
Call a specialized ambulance team. When making a call, you need to describe the problem as clearly as possible to the operator taking the call, so that doctors with the necessary equipment are sent to the victim.
If a person loses consciousness due to carbon monoxide poisoning, it is necessary to lay him on his side. Next, bring a cotton wool soaked in ammonia to his nose (at a distance of 2 cm from the nostrils) and gently wave it. Remember that if you bring ammonia too close, the powerful effects of ammonia can lead to paralysis of the respiratory center.
If a person is not breathing, then you need to immediately start doing artificial respiration. If the victim has not only lost consciousness, but also has no signs of cardiac activity, then artificial respiration should be supplemented with chest compressions. Such first aid for carbon monoxide poisoning should be done until the arrival of a medical team or until the person begins to actively show signs of life.
If the poisoned person is conscious, he must be laid down and try to ensure the maximum flow of fresh air. For this purpose, you can fan it with newspaper, turn on the air conditioner and fan. You should put a warm heating pad or mustard plasters at your feet. It can be of great benefit to the victim alkaline drink(per 1 liter warm water– 1 tbsp. spoon of soda).

We found out what to do in case of carbon monoxide poisoning and how to provide first aid. Now let's talk about one more thing important point: It is important for people involved in providing assistance to protect themselves. When removing a person from a poisoned room, you need to cover your airways with gauze or a handkerchief.

What treatment is provided in the hospital?

Victims who received moderate or severe degree poisoning are subject to mandatory hospitalization. The main antidote is 100% oxygen. Its uninterrupted intake into the body is 9-16 l/min. occurs through a special mask placed on the patient’s face.

In severe cases, the victim undergoes tracheal intubation and is connected to a ventilator. In a hospital setting it is also carried out infusion therapy using a course of drips with sodium bicarbonate - this helps to correct hemodynamic disorders. Solutions "Chlosol" and "Quartasol" are also used for intravenous infusion.

Another drug used by doctors to help victims of carbon monoxide poisoning is Acizol. This drug is administered intramuscularly into the body. Its action is based on accelerating the breakdown of carboxyhemoglobin while simultaneously saturating the blood with oxygen. "Acyzol" reduces toxic effect CO on muscle tissue and nerve cells.

Providing assistance for carbon monoxide poisoning using folk remedies

The following traditional medicine recipes can be used at home for mild carbon monoxide poisoning. Here are some easy-to-make home remedies that have very effective antitoxic properties:

Dandelion tincture (only roots are used). To prepare the infusion, pour 10 g of finely ground dry raw materials into a glass of boiling water. Boil for about 20 minutes. and then leave for 40 minutes. Then strain and dilute warm water(100 ml). Take the product 3 or 4 times a day, one tablespoon at a time.
Lingonberry-cranberry tincture. What to do after carbon monoxide poisoning with its help? First, for cooking you will need 200 g of lingonberries and 150 g of rose hips. The ingredients are ground as thoroughly as possible and 350 ml of boiling water is poured. Infuse the berries for 3 hours, then strain the product and consume 2 tbsp orally 5 to 6 times a day. spoons.
Tincture of knotweed herb. 3 tbsp. spoons of crushed dry knotweed are poured into 0.5 liters of boiling water. Leave for at least 3 hours, then strain and drink a glass 3 times a day.
Rhodiola rosea tincture with alcohol. You do not need to prepare this drug yourself; it is sold at any pharmacy. The method of administration is as follows: 7-12 drops are added to a glass of water. Drink half a glass twice a day.

Preventive measures to prevent CO poisoning

As already mentioned, carbon monoxide is often responsible for the death of people. To protect yourself and your loved ones, you need not only to know what to do in case of carbon monoxide poisoning, but also try to follow preventive measures, which include the following:

It is necessary to regularly check the condition of chimneys and ventilation shafts. It is especially important to pay attention to this before the start of the heating season.
Before using flammable fuel appliances, you should always check that they are in good working order. If a fault is identified in a timely manner, many problems can be avoided.
If the room has poor ventilation, additional measures must be taken to ventilate it regularly.
Do not start your car in a closed, unventilated garage and do not sleep in a car with the engine running.
Purchase a special sensor that responds to CO leaks and install it in your house or apartment.
Try to avoid being near busy highways, especially during their busiest hours.

Carbon monoxide sensor

As already mentioned, the presence of carbon monoxide in the air cannot be detected using one’s own senses. To protect yourself and your loved ones from harm, you can purchase a carbon monoxide detector. This small device will continuously monitor the composition of the air in the room. After all, first aid in case of carbon monoxide poisoning should be almost instantaneous, otherwise you may not have time.

In the event that CO levels exceed the required norm, the sensor will notify the owners with sound and light signals. Such devices can be used for household and industrial purposes. The latter have a more complex structure and are designed for large areas.

Risk group

To some extent, we are all at risk and, under certain circumstances, can suffer from CO. Therefore, each of us should know well what to do in case of carbon monoxide poisoning. However, there are a number of professions whose representatives are at greatest risk. These include:

welders;
taxi drivers;
auto repair shop workers;
diesel engine operators;
firefighters;
workers of breweries, boiler houses;
personnel of steel foundries, oil refining, pulp and paper production, etc.

Conclusion

It is very important to know what to do if you have carbon monoxide poisoning. IN difficult situations People with the necessary knowledge and skills can provide the greatest help to victims. The main thing is not to panic, but to act as quickly, clearly and consistently as possible.

Carbon monoxide poisoning is a pathological process that has severe form intoxication syndrome. Without proper medical care, death may occur. Increased concentrations of carbon monoxide (CO) block the delivery of oxygen in the bloodstream, causing the entire body and especially the brain to suffer. Unfortunately, brain hypoxia is irreversible.

Carbon monoxide is dangerous because it is almost invisible when inhaled and does not have a pronounced unpleasant odor, colors. In order to help a person with carbon monoxide poisoning, you need to know the symptoms, first aid and treatment methods. After all, intoxication occurs quickly and has serious consequences: all human organs are affected, often ending in his death.

First aid for carbon monoxide poisoning of people who happen to be nearby can restore the life of someone in trouble and save them from serious consequences. Such intoxication is classified by ICD-10 code T58 and requires the administration of an antidote.

What happens with carbon monoxide poisoning?

After entering the blood, carbon monoxide blocks hemoglobin, forming a complex with it - carboxyhemoglobin, which is deprived of the ability to transport oxygen to tissues. This leads to oxygen starvation every cell of the human body, but first of all in such conditions the brain suffers from hypoxia. In addition, carbon monoxide is actively involved in various oxidative reactions, which also negatively affects tissues and organs.

The severity of the clinical picture of carbon monoxide intoxication directly depends on how much of a dangerous substance a person inhaled, how much carboxyhemoglobin was formed in his blood, and, accordingly, how much hemoglobin cannot perform its function. So, the first symptoms of poisoning appear if 10-20% of hemoglobin is blocked, but if 50% or more, the person simply falls into a coma and dies if first aid is not provided in a timely manner.

When does carbon monoxide poisoning occur?

Carbon monoxide is a colorless, poisonous, tasteless and odorless gas that fills the air space during combustion processes and intensively interacts with hemoglobin, preventing the penetration of oxygen into the body’s tissues, which stimulates the occurrence of hypoxia. When CO enters the human body, it begins to take part in oxidation reactions, thereby changing the biochemical balance.

The big danger with carbon monoxide poisoning is that it is almost impossible to recognize: the effects of carbon monoxide are practically undetectable. That's why the only way Protecting your health from carbon monoxide poisoning is understanding when such a threat occurs and then preventing these incidents.

Precedents when first aid is urgently needed for carbon monoxide poisoning happen in everyday life:

If you are close to highways or closed parking spaces. Vehicle exhaust contains approximately 1–3% carbon monoxide, and to obtain severe carbon monoxide poisoning, 0.1% CO in the air is sufficient.
At long work in the garage with closed doors, for example, when the vehicle engine warms up for a long time.
If there is poor ventilation of heating columns or such equipment is located in cramped rooms, i.e. in conditions where the oxygen level decreases, the carbon monoxide content after oxygen combustion increases and the likelihood of poisoning increases.
In case of violation of the rules for the use of stove installations in bathhouses, country cottages with stove heating systems. If a person closes the stove damper before the set time, then Great chance become a victim of carbon monoxide poisoning.
In case of fire.
When working in hazardous industries.

What is the danger of carbon monoxide?

Carbon monoxide is a product of combustion of various substances; it is very toxic and poisonous. When inhaled, it spreads quickly and enters the bloodstream. If a little more than 1% of this gas accumulates in the air, a person will not live even 5 minutes. It happens that people “burn out” due to improper use of stove heating.

The disease with ICD-10 code T58 poses a mortal danger for the following reasons:

Its presence in the room is imperceptible; when inhaled, it is not felt.
Able to seep through thick layers of any substance - through the ground, wooden partitions and doors.
Not retained by porous gas mask filters.

How does gas enter the body?

The main reason for the rapid death of a victim from CO2 occurs because the gas completely blocks the supply of O2 to the cells of vital organs. In this case, red blood cells (erythrocytes) die. Hypoxia of the body occurs.

The cells of the brain and nervous system are the first to experience a lack of air. Severe headache, vomiting, loss of balance appears. Poisonous gas penetrates the protein skeletal muscles and heart muscle. The rhythm of contractions is lost, the blood flows unevenly, and the person begins to choke. The heart beats very weakly and quickly. Movements are constrained.

Symptoms, causes of poisoning and treatment

The first signs of intoxication appear the sooner the higher the concentration of CO2 in the atmosphere and the longer a person inhales poisoned air. Based on these conditions, the degree of intoxication is determined.

At 1.2 degrees of poisoning, the following symptoms appear:

the whole head hurts, with foci of unbearable pain in the temples and frontal part;
noise in ears;
loss of coordination and balance;
vomit;
blurred vision, blurred vision;
lethargy;
temporary weakening of hearing and vision;
short fainting.

Severe carbon monoxide poisoning will be accompanied by obvious painful symptoms:

the person is unconscious;
convulsions;
coma;
uncontrolled urination.

Heart rhythms at mild poisoning become more frequent and aching pains appear in the heart area. In the third degree of damage, the pulse reaches 140 beats per minute, but is very weak. Often followed by a real threat of myocardial infarction.

During carbon monoxide poisoning respiratory organs are affected first. If the dose of intoxication is insignificant, shortness of breath and rapid shallow breathing are observed. In severe cases, the respiratory function is severely impaired, the person inhales air intermittently and in small portions.

Changes in the skin and mucous membranes during CO2 intoxication are not noticeable. Sometimes the face and upper body become red. With significant poisoning, the skin turns pale, the mucous membranes lose normal look. The blood supply to the epidermis, like the whole body, is disrupted.

The condition of a person who has been poisoned by fumes varies depending on the time he spent in the room poisoned by the toxic substance and its amount in the air. There are mild, moderate, severe harm to health, pathological or chronic poisoning. At the initial stage, a person may feel nauseated, muscle weakness, decreased hearing sensitivity, body tremors, pulsations in the head, and near fainting.

Remember that professional medical help must be called at the first sign of feeling unwell. You should not wait until the person loses consciousness. At medium degree poisoning, weakness of the body, a sharp decrease in physical and mental activity, intolerance to harsh light, sound or smells, memory loss, body tremors or loss of muscle coordination.

With prolonged or concentrated exposure, a serious condition of the patient is observed. Its signs are a coma, accompanied by loss of consciousness, involuntary bowel movements, convulsions, a significant increase in body temperature, problems with breathing and pulse. If a person is not revived within a short period of time, death can occur due to paralysis of the respiratory system.

Causes of carbon monoxide intoxication

You can select following reasons carbon monoxide poisoning:

being in a closed garage where workers are working on a running car;
inhalation of car exhaust fumes when near busy highways;
improper use of home stoves and boilers: if you close the damper too early, high probability get burned from carbon monoxide poisoning.
in case of fires in apartments and houses;
in chemical production.

The considered causes of intoxication are the most common. As you can see, carbon monoxide poisoning very often occurs due to our carelessness.

IN medical practice known cases atypical manifestations CO2 poisoning:

a sharp decrease in blood pressure, anemia of the upper layers of the skin, fainting;
state of euphoria - the patient behaves animatedly, excitedly, reacts inadequately to real events. Then the activity abruptly comes to naught, loss of consciousness occurs, which leads to cardiac arrest and cessation of breathing.

What consequences can gas poisoning cause?

Most unpleasant consequence carbon monoxide poisoning - the appearance of neuropsychiatric symptoms after a latent period of poisoning, which can last from 1 to 6 weeks. 10-30% of people after severe carbon monoxide poisoning experience symptoms such as memory loss, personality changes, euphoria, lack of self-criticism and the ability to abstract thinking, and inability to nitrate. Carbon monoxide poisoning in pregnant women is serious threat for life and neuropsychic development child.

After poisoning, CO often appears inflammatory processes in the respiratory tract, and in severe cases even pulmonary edema and pulmonary hemorrhage. In acute poisoning, acute toxicity may occur. liver failure, trophic skin disorders, renal failure, myoglobinuria that occurs for no apparent reason. There may be disturbances to the sensory organs, especially hearing and vision.

Signs of carbon monoxide poisoning

The symptoms of carbon monoxide poisoning depend on the amount of carbon monoxide released into the air and general condition human health. There are a number of symptoms general group characteristic of carbon monoxide poisoning:

pain in the head, tapping in the temporal region;
urge to feel sick;
decreased attentiveness;
decline in concentration;
craving for sleep;
red rashes on the skin;
inflammation of the mucous membranes;
tearfulness;
cutting pain in the eyes;
pulse failures;
feeling of pain in the chest area;
dyspnea,
appearance of cough;
dry throat;
high blood pressure;
Possibly hallucinations.

With a mild degree of carbon monoxide intoxication, a baby may have the following symptoms: headache in the forehead and temples, “pulsation in the temples,” tinnitus, dizziness, vomiting, muscle weakness. Increased heart rate and breathing may occur, as well as fainting. Most early symptom- impaired color perception and decreased reaction speed.

With moderate intoxication, loss of consciousness occurs for several hours or large memory loss. The child may experience tremors and poor coordination of movements. A severe form of intoxication is characterized by a prolonged coma, rigidity of the muscles of the limbs, brain damage, clonic and tonic convulsions, intermittent breathing, and a temperature of 39-40 ° C. This is a very dangerous condition, as death can occur from respiratory paralysis.

In severe cases of intoxication, visual impairment, damage to the skin and hair, changes in the respiratory and circulatory system, and blood changes may occur.

How to help with carbon monoxide poisoning in a child?

First, you need to take the sick baby out into the fresh air in a supine position. After that, urgently call " ambulance"! Experts will be able to accurately determine the degree of intoxication. If doctors recommended home treatment, then the main “medicine” for the child will be complete rest. Warm the baby's limbs at home (heating pads and warm mustard plasters on the feet will help).

After intoxication, prolonged oxygen inhalation procedures are also good. Ventilate the room and wet clean it more often. Aromatherapy sessions are also good. In case of severe carbon monoxide intoxication, the child needs emergency hyperbaric special oxygen therapy.

How to avoid carbon monoxide poisoning?

It must be remembered that carbon monoxide is present everywhere in environment and is a “silent killer”, has no smell or color, i.e. cannot be detected. Smoking is also a source of carbon monoxide. What not to do in Everyday life to avoid carbon monoxide poisoning?

Stay in the bathroom for a long time with the gas heater on, if it is there, for example, fill the bathtub with water while in it, read, smoke, fall asleep in the bathtub.
Allow the use of hot water in the kitchen if someone is in the bathroom, and the common water heater is also located in the bathroom.
Heat the apartment using a gas stove (oven or all burners turned on).
Cook, fry and bake with all 4-5 gas stove burners turned on at the same time.
Heat the room using a stove that has gaps in it.
Close the stove damper while the combustion process is still in progress.
Melt the stove overnight (without supervision).
Repair a car in a garage with the engine running and the windows and doors closed.
Smoking while lying in bed (you can fall asleep without extinguishing your cigarette, which will cause a fire and carbon monoxide poisoning).
Take a bath, do laundry, cook while intoxicated (boiling water, burning food, carbon monoxide poisoning).
Be distracted by other things while cooking.
Study independently (without involvement) professional help) repair of gas and ventilation devices.

First aid for carbon monoxide poisoning

What to do if you have carbon monoxide poisoning? Algorithm of actions:

In case of carbon monoxide poisoning, the victim must first call emergency assistance, no matter what state a person is in. Symptoms of carbon monoxide poisoning may not appear immediately, and lost time will have a serious impact on the patient’s condition. Only a medical professional can reliably assess his state of health. No one can say how deeply the poisons penetrated into the blood. Providing first aid for carbon monoxide poisoning and correct actions those around you will reduce the possibility of severe consequences. There is no time to waste.
Helping a patient before doctors arrive consists of isolating him from a burning building with high concentration CO2. You must immediately close the source of the poisonous gas, open the windows and doors, and transport the person outside the room with the fumes. If possible, we should try to increase the flow of oxygen into the patient’s lungs. Can be used oxygen cushion, oxygen concentrator, special gas mask.
These actions are possible if devices are available nearby. Usually, they don't happen. You need to know how to provide first aid for carbon monoxide poisoning. The victim should be placed on his side horizontally, with his head slightly raised. Then you need to relax the outer clothing that restricts breathing, the buttons on the collar and chest, and remove heavy, dense items.
It is necessary to bring the patient to his senses as soon as possible. Then the blood intensely rushes to the brain. For this procedure, you need to use ammonia, which should be in any car first aid kit. A cotton wool soaked in it should be brought to the nostrils. To improve blood flow, mustard plasters can be placed on the chest area and back. This cannot be done on the projection of the heart. If a person regains consciousness, he should be given hot sweet tea or coffee to increase blood pressure.
In case of cardiac arrest, before the doctor arrives, you can try to “start the engine” manual massage. They do it like this - place the palms on the heart area and make quick, strong pressure on the sternum (30 times). Before and after this, mouth-to-mouth artificial respiration is performed 2 times. If a person is conscious, he is breathing on his own, he should be covered with a warm blanket and ensure peace. Body temperature should be monitored. In this position, the victim must wait for the doctor to arrive. He makes a diagnosis using ICD-10 code T58.

First aid

Doctor providing on-site medical assistance, must immediately administer an antidote to the patient. If a person feels normal, then hospitalization is not necessary. The victim is advised to see a doctor the next day to rule out the possibility of complications.

The following categories of people with CO2 poisoning should definitely go to a hospital for treatment after a PMP:

Women are in an “interesting” position.
People who are registered with a cardiologist or who have experienced loss of consciousness.
Victims with noticeable symptoms - hallucinations, delusions, loss of orientation.
If your body temperature is below normal.

Poisoning often ends in the death of the victim. But people nearby can help avoid this.

To undergo complete rehabilitation, the victim must be under the supervision of a doctor for some time on sick leave according to ICD-10 code T58.

To avoid carbon monoxide poisoning when helping in a fire, you need to protect your respiratory tract with a mask made of wet fabric, and not stay in the smoke for a long time.

Treatment after carbon monoxide poisoning according to ICD-10 code T58 consists of removing the effects of poisonous toxins. This is the cleansing of organs and restoration of their functions.

Main causes of carbon monoxide poisoning

All types of devices that operate on the basis of combustible fuel emit carbon monoxide during operation. And if these mechanisms are out of order or damaged, health problems cannot be avoided.

The main dangers are:

A car if left running indoors. The gas it releases will gradually fill the entire space.
Various household heating appliances with improper installation or operation.
Buildings where the chimney does not work properly, carbon monoxide does not pass through the shaft and stagnates in the living quarters.
Household fires. Frequent cases of poisoning by fumes if a person was in close proximity to the source of fire.
Grill on charcoal. In gazebos and indoors where the device is installed, harmful gas accumulates. Therefore, it is imperative to provide the grill with a good ventilation system.
Scuba gear and other breathing apparatus. It is necessary to carefully ensure that they have a high-quality supply of fresh air. Read more:

In addition, proper ventilation should be ensured in new houses or apartments. Household carbon monoxide accumulates over time, and if it does not drain naturally, it will cause harm to the body.

Folk remedies to eliminate gas poisoning

Recipes folk remedies:

Cranberry-lingonberry infusion. Required: 150 grams of dried cranberries and 200 grams of lingonberries. The ingredients are thoroughly ground. Afterwards they need to be filled with 350 milliliters of boiling water. The broth should be infused for 2-3 hours, then it should be strained. Medicine consumed 5-6 times a day, 2 tablespoons.
Knotweed infusion. Helps remove harmful toxins from the body as quickly as possible. Preparation: pour 3 tablespoons of chopped dry herbs into 0.5 liters of boiling water. Leave for 3 hours, strain. Take 1 glass 3 times a day.
Alcohol infusion of Rhodiola rosea extract. The tincture can be bought at any pharmacy kiosk. Recommended dosage: dissolve 7-12 drops of extract in a glass of water. Drink half a glass twice a day. You can drink the infusion clean water, sweetened with a little honey.
Dandelion root infusion. This plant has excellent antitoxic effects. Pour 10 grams of dry crushed raw materials with 250 milliliters of boiling water. Cook over low heat for 20 minutes. Then let the broth brew for another 40 minutes. Strain, dilute with 100 milliliters of warm boiled water. Drink 3-4 times a day, 1 tablespoon.

Carbon monoxide has no odor and is not visible to the eye. It is produced when carbon-containing substances burn. Carbon monoxide poisoning is often fatal. There are known cases of mass deaths that occur during explosions. Carbon monoxide impairs the flow of oxygen to tissues and organs. If the concentration of a hazardous substance increases, irreversible changes and death.

According to the International Classification of Diseases (ICD 10), when carbon monoxide accumulates in the body, code T58 is assigned.

Causes

Carbon monoxide is more easily incorporated into the respiratory protein, displacing oxygen. It is not immediately possible to detect the effects of carbon monoxide on the body. Intoxication develops when the concentration of toxic carboxyhemoglobin is more than 10%. The time spent in gas-contaminated conditions is of great importance. When a person breathes smoke long time, brain tissue begins to starve.

The pathogenesis of the disease considers not only the manifestations of the influence of carbon monoxide, but also the causes of poisoning. Thus, a large proportion of people are poisoned in the garage when the car is running, incorrect operation of the stove, breakdown of heating and exhaust systems, geysers, etc.

You can get poisoned in a car if carbon monoxide accumulates in the body. The danger of intoxication lies in the fact that the injured person does not immediately understand that he has been exposed to toxic effects. The mechanism of intoxication involves the development of tissue hypoxia. The pathological condition in which shortness of breath and migraine pain appear is called second-degree poisoning. Interruptions in the functioning of the brain and cardiovascular system accompany chronic carbon monoxide poisoning. In severe cases of poisoning, when the CO content reaches 0.3% or higher, the person loses consciousness and dies.

The toxic component provokes conditions that occur with other forms of intoxication: weakness, apathy. If victims inhaled carbon monoxide in a sauna, steam room or bathhouse, they may confuse such manifestations with the relaxing effects of heat. The likelihood of CO intoxication is higher when high temperature air, the risk group also includes people with heart disease, who are more susceptible to poisoning.

Often, poisoning occurs in an apartment due to a fire that ignites. The fire spreads rapidly, the amount of carbon monoxide increases sharply. In this case, poisoning is exposed significant amount people: apartment residents, neighbors.

Symptoms

In case of prolonged exposure to gas, nerve structures are destroyed, tissue hypoxia, convulsions, and confusion may develop. Symptoms of carbon monoxide poisoning are determined by the amount of carbon monoxide in the air. So, early signs Carbon monoxide poisoning is considered:

decreased concentration;

dizziness, disorientation, tinnitus or nausea;

irritability and anxiety;

heaviness in the chest;

pulse more than 90 beats per minute;

paroxysmal headache, pounding in the temples;

decreased visual acuity, blurred vision.

In the syncope form of intoxication, there is pallor of the skin, a drop in blood pressure, nausea, and impaired heart rate. Signs of severe carbon monoxide poisoning include loss of consciousness, convulsions and coma.

With prolonged exposure to carbon monoxide, symptoms increase. Manifestations of intoxication have their own characteristic features. First there is euphoria and excitement. Then the clinical picture of developing carbon monoxide poisoning is aggravated due to loss of orientation and memory loss. Impaired motor skills may occur due to neurological disorders. With moderate intoxication, the level of CO in the body reaches 40-50%, and collapse is possible.

Symptoms in a child who has inhaled carbon monoxide develop faster - children only need to stay in a gas-filled room for 3-5 minutes to experience hypoxia of brain tissue. The child is delirious, the skin is brightly colored, resembling cadaveric spots by color.

First aid

How to efficiently administer first aid for carbon monoxide poisoning? The burnt person is taken out of the room into the air. In case of a quick response, it will be possible to bring the poisoned person to his senses at the scene of the incident and avoid possible complications intoxication. It is impossible to evacuate victims without a protective suit, in as a last resort, hold their breath and carry people out. Call an ambulance immediately.

In case of mild carbon monoxide poisoning, the victim's collar and cuffs are unbuttoned and air flow to the tissues is ensured. In case of carbon monoxide poisoning, it is necessary, first of all, to get away from the source of intoxication. The further procedure includes:

bring the burnt person to consciousness with the help of ammonia;
give caffeine-containing drinks: tea, coffee;
rub your limbs to stimulate blood circulation;
give an alkaline drink to neutralize CO;
apply a heating pad to your limbs.

First aid for carbon monoxide poisoning in case of suffocation requires mouth-to-mouth breathing. First of all, the head is slightly thrown back, the jaw is extended, and the nose is pinched with the hand. Two artificial entries are made without violent action, but with sufficient intensity. In the absence of cardiac activity, first aid involves indirect massage heart and artificial respiration. If the above measures do not produce results, it is necessary to repeat cardiopulmonary resuscitation. If the poisoned person is unconscious, he should be placed on his side.

Providing first aid for clinical carbon monoxide poisoning requires a lot of effort. It is difficult for a beginner to master the PMP algorithm without preparation, so emergency care for carbon monoxide poisoning is trusted to professionals, especially during pregnancy and during pregnancy. childhood. First aid rules require the participation of a physician in resuscitation efforts.

What to do with someone who is burned after carbon monoxide poisoning? At home, the following can be done to help the victim: give more fluids, take 1 tsp. activated carbon every hour, diluting the tablets in oatmeal broth.

Treatment

To make a diagnosis, a comprehensive examination is necessary. The gas composition of the mixture and acid-base balance are determined, and the hemoglobin level is assessed. Treatment and rehabilitation after carbon monoxide poisoning are determined by the intensity of the toxic effect.

Often, in case of severe carbon monoxide poisoning, an antidote is used - pure oxygen. It can hardly be called an antidote, but it is the only substance that the body needs in case of acute poisoning carbon monoxide. After resuscitation measures connect the oxygen mask. In the hospital they carry out complex treatment, eliminating the consequences of hypoxia.

Based on the degree of poisoning, carbon monoxide detoxification is chosen. Intensive therapy in case of carbon monoxide poisoning, it involves administering the medication “Azicol” and a glucose solution, taking absorbent tablets. In case of acute poisoning, oxygen inhalation is prescribed, the mucous membranes are moistened, and in case of hypotension, an ephedrine solution is administered.

Ascorbic acid is especially useful for patients. At the recovery stage, it is prescribed healthy eating with a high content of antioxidants. Vitamins B1 and B6 are prescribed intravenously. At painful attacks that occur due to burns, analgin is administered subcutaneously or intravenously. Treatment methods such as hemodialysis and lymphatic drainage are designed to revive oppressed cells.

Complications and consequences

The inevitable outcome of poisoning in the absence of medical care is respiratory arrest and death. If help for poisoning was provided late, coma develops. Complicating factors also lead to death: the presence of heart and vascular diseases, previous heart attacks, strokes, and brain pathologies. Intoxication caused by the huge release of carbon monoxide into the air during explosions and fires is fatal.

Negative consequences of long-term carbon monoxide poisoning include interruptions in the functioning of the central and peripheral nervous system, headaches, and ophthalmological disorders. Hypoxia has harmful influence on brain activity and gives complications such as amnesia, neuritis, and decline of cognitive functions. Long-term consequences of long-term carbon monoxide poisoning include pneumonia and myocarditis.

Carbon monoxide poisoning

Carbon monoxide poisoning- an acute pathological condition that develops as a result of carbon monoxide entering the human body is dangerous to life and health, and without qualified medical care can lead to death.

Carbon monoxide enters atmospheric air for any type of combustion. In cities, mainly as part of exhaust gases from internal combustion engines. Carbon monoxide actively binds to hemoglobin, forming carboxyhemoglobin, and blocks the transfer of oxygen to tissue cells, which leads to hemic hypoxia. Carbon monoxide is also included in oxidative reactions, disturbing the biochemical balance in tissues.

Poisoning is possible:

in case of fires;

in production, where carbon monoxide is used for the synthesis of a number of organic substances (acetone, methyl alcohol, phenols, etc.);

in garages with poor ventilation, in other unventilated or poorly ventilated rooms, tunnels, since the car exhaust contains up to 1-3% CO according to standards and over 10% if the carburetor engine is poorly adjusted;

when spending a long time on or near a busy road. On major highways, the average CO concentration exceeds the toxicity threshold;

at home when there is a leak of lighting gas and when the stove dampers are untimely closed in rooms with stove heating (houses, baths);

when using low-quality air in breathing apparatus.

General information

Carbon monoxide poisoning ranks fourth in the list of the most frequently observed poisonings (after alcohol poisoning, drug and drug poisoning). Carbon monoxide, or carbon monoxide (CO), occurs wherever conditions exist for incomplete combustion of carbon-containing substances. CO is a colorless, tasteless gas; its odor is very weak, almost imperceptible. Burns with a bluish flame. A mixture of 2 volumes of CO and 1 volume of O2 explodes when ignited. CO does not react with water, acids and alkalis. Carbon monoxide is colorless and odorless, so carbon monoxide poisoning most often occurs unnoticed. The mechanism of the effect of carbon monoxide on humans is that, when it enters the blood, it binds hemoglobin cells. Then hemoglobin loses its ability to carry oxygen. And the longer a person breathes carbon monoxide, the less workable hemoglobin remains in his blood, and the less oxygen the body receives. A person begins to choke, a headache appears, and consciousness becomes confused. And if you don’t go out into the fresh air in time (or don’t take someone who has already lost consciousness out into the fresh air), then a fatal outcome is possible. In case of carbon monoxide poisoning, sufficient for a long time so that hemoglobin cells can completely clear carbon monoxide. The higher the concentration of carbon monoxide in the air, the faster the life-threatening concentration of carboxyhemoglobin in the blood is created. For example, if the concentration of carbon monoxide in the air is 0.02-0.03%, then in 5-6 hours of inhaling such air a carboxyhemoglobin concentration of 25-30% will be created, if the concentration of CO in the air is 0.3-0.5% , then the lethal content of carboxyhemoglobin at the level of 65-75% will be achieved after 20-30 minutes of a person’s stay in such an environment. Carbon monoxide poisoning can occur suddenly or slowly, depending on the concentration. At very high concentrations, poisoning occurs quickly, characterized by rapid loss of consciousness, convulsions and respiratory arrest. In blood taken from the region of the left ventricle of the heart or from the aorta, a high concentration of carboxyhemoglobin is detected - up to 80%. With a low concentration of carbon monoxide, symptoms develop gradually: muscle weakness appears; dizziness; noise in ears; nausea; vomit; drowsiness; sometimes, on the contrary, short-term increased mobility; then movement coordination disorder; rave; hallucinations; loss of consciousness; convulsions; coma and death from paralysis of the respiratory center. The heart may continue to contract for some time after breathing has stopped. There have been cases of death from the consequences of poisoning even 2-3 weeks after the poisoning event.

Acute effects of carbon monoxide poisoning relative to ambient concentrations in parts per million (concentration, ppm): 35 ppm (0.0035%) - headache and dizziness during six to eight hours of continuous exposure 100 ppm (0.01%) - minor headache after two to three hours of exposure 200 ppm (0.02%) - minor headache after two to three hours of exposure, loss of criticism 400 ppm (0.04%) - frontal headache after one to two hours of exposure 800 ppm (0.08%) - dizziness, nausea and convulsions after 45 minutes of exposure; loss of senses after 2 hours 1600 ppm (0.16%) - headache, tachycardia, dizziness, nausea after 20 minutes of exposure; death in less than 2 hours 3200 ppm (0.32%) - headache, dizziness, nausea after 5-10 minutes of exposure; death after 30 minutes 6400 ppm (0.64%) - headache, dizziness after 1-2 minutes of exposure; convulsions, respiratory arrest and death after 20 minutes 12800 ppm (1.28%) - unconscious after 2-3 breaths, death in less than three minutes

Concentration 0.1 ppm - natural atmospheric level (MOPITT) 0.5 - 5 ppm - average level in houses 5 - 15 ppm - next to a properly adjusted gas stove in the house 100 - 200 ppm - from exhaust gases from cars in the central square of Mexico City 5000 ppm - in smoke from a wood stove 7000 ppm - in warm exhaust gases from cars without a catalyst

The diagnosis of poisoning is confirmed by measuring the level of carbon monoxide in the blood. This can be determined by measuring the amount of carboxyhemoglobin compared to the amount of hemoglobin in the blood. The carboxyhemoglobin ratio in the hemoglobin molecule can average up to 5%; in smokers who smoke two packs a day, levels up to 9% are possible. Intoxication appears when the ratio of carboxyhemoglobin to hemoglobin is above 25%, and the risk of mortality is at a level of more than 70%.

Concentration of CO in the air, carboxyhemoglobin HbCO in the blood and symptoms of poisoning.
% about. (20°C)	mg/m 3	Time impact, h	in blood, %	Main signs and symptoms of acute poisoning
				A decrease in the speed of psychomotor reactions, sometimes a compensatory increase in blood flow to vital important bodies. In persons with severe cardiovascular insufficiency - chest pain with physical activity, shortness of breath
				Minor headache, decreased mental and physical performance, shortness of breath with moderate physical exertion. Visual perception disorders. May be fatal to fetuses and persons with severe heart failure

				Throbbing headache, dizziness, irritability, emotional instability, memory disorder, nausea, loss of coordination of small hand movements

				Severe headache, weakness, runny nose, nausea, vomiting, blurred vision, confusion

				Hallucinations, severe ataxia, tachypnea
				Fainting or coma, convulsions, tachycardia, weak pulse, Cheyne-Stokes breathing

				Coma, convulsions, respiratory and cardiac depression. Possible death

				Deep coma with decreased or absent reflexes, thready pulse, arrhythmia, death.
				Loss of consciousness (after 2-3 breaths), vomiting, convulsions, death.

Symptoms:

For mild poisoning:

headache appears

knocking in the temples,

dizziness,

chest pain,

dry cough,

lacrimation,

visual and auditory hallucinations are possible,
redness of the skin, carmine red coloring of the mucous membranes,
tachycardia,
increased blood pressure.

in case of moderate poisoning:

drowsiness,

possible motor paralysis with preserved consciousness

in case of severe poisoning:

loss of consciousness, coma

convulsions,

involuntary passage of urine and feces,

breathing disorder that becomes continuous, sometimes Cheyne-Stokes type,

dilated pupils with weakened reaction to light,

sharp 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.

Help for carbon monoxide poisoning

The first symptoms of poisoning can develop after 2 - 6 hours of exposure to an atmosphere containing 0.22-0.23 mg of CO per 1 liter of air; severe poisoning with loss of consciousness and death can develop after 20 - 30 minutes at a CO concentration of 3.4 - 5.7 mg/l and after 1-3 minutes at a poison concentration of 14 mg/l. The first symptoms of poisoning are headache, heaviness in the head, tinnitus, nausea, dizziness and palpitations. With further stay in a room whose air is saturated with carbon monoxide, the victim begins to vomit, general weakness increases, and severe drowsiness and shortness of breath appear. The skin turns pale. If a person continues to inhale carbon monoxide, his breathing becomes shallow and convulsions occur. Death occurs from respiratory arrest due to paralysis of the respiratory center.

First aid for carbon monoxide poisoning

First of all, it is necessary to take the victim out into the fresh air (in the warm season outside, in the cold season - in a ventilated room, on a staircase). The person is placed on his back and tight, constricting clothing is removed; The victim's entire body is rubbed with vigorous movements; A cold compress is placed on the head and chest; If the victim is conscious, it is recommended to give him warm tea; If a person is unconscious, you need to bring a cotton swab moistened with ammonia to his nose; If there is no breathing, it is necessary to start artificial ventilation of the lungs and immediately call an ambulance. To prevent poisoning, it is recommended to follow safety precautions at work, install a well-functioning ventilation system in garages, and in houses with a stove, close the damper only after there are no blue lights left in the ash.

Treatment of carbon monoxide poisoning

In case of CO poisoning, prompt removal of the poison from the body and specific therapy are necessary. The victim is taken out into the fresh air, and upon the arrival of medical workers, inhalations of humidified oxygen are carried out (in an emergency setting using KI-Z-M, AN-8 devices). In the first hours, pure oxygen is used for inhalation, then they switch to inhalation of a mixture of air and 40-50% oxygen. In specialized hospitals, oxygen inhalation is used under a pressure of 1-2 atm in a pressure chamber (hyperbaric oxygenation). In case of breathing disorders, before inhaling oxygen, it is necessary to restore the patency of the respiratory tract (oral toilet, duct insertion), perform artificial respiration up to tracheal intubation and artificial ventilation of the lungs. In case of hemodynamic disorders (hypotension, collapse), most often resulting from damage to the central nervous system, in addition to the intravenous administration (boost) of analeptics (2 ml of cordiamine, 2 ml of 5% ephedrine solution), rheopolyglucin (400 ml) should be administered intravenously drip in combination with prednisolone (60-90 mg) or hydrocortisone (125-250 mg). In case of CO poisoning, great attention must be paid to the prevention and treatment of cerebral edema, since the severity patients' conditions, especially with a long-term disorder of consciousness, is determined cerebral edema, developed as a result of hypoxia. At the prehospital stage, patients are administered intravenously 20-30 ml of a 40% glucose solution with 5 ml of a 5% solution ascorbic acid, 10 ml of a 2.4% solution of aminophylline, 40 mg of Lasix (furosemide), intramuscularly - 10 ml of a 25% solution of magnesium sulfate. It is very important to eliminate acidosis, for which, in addition to measures to restore and maintain adequate breathing, it is necessary to administer a 4% sodium bicarbonate solution intravenously (at least 600 ml). In a hospital setting, with severe symptoms of cerebral edema (neck stiffness, convulsions, hyperthermia), a neuropathologist carries out repeated lumbar punctures, craniocerebral hypothermia is required, in the absence of a special apparatus - ice on the head. In order to improve metabolic processes in the central nervous system sick, especially with severe poisoning, vitamins are prescribed, especially ascorbic acid (5-10 ml of 5% solution intravenously 2-3 times a day), vitamins B1, (3-5 ml of 6% solution intravenously), B6 (3-5 ml of 5% solution 2-3 times a day intravenously). To prevent and treat pneumonia, antibiotics and sulfonamides should be administered. Severely ill patients with CO poisoning require careful care; it is necessary to cleanse the skin of the body, especially the back and sacrum, change body position (turning on its side), heavy percussion chest(effleurage with the side surface of the palm), vibration massage, ultraviolet irradiation chest with erythemal doses (by segments). In some cases, CO poisoning can be combined with other severe conditions, significantly complicating the course of intoxication and often having decisive influence on the outcome of the disease. Most often this is a burn of the respiratory tract, which occurs when inhaling hot air or smoke during a fire. As a rule, in these cases, the severity of the patient’s condition is due not so much to carbon monoxide poisoning (which can be mild or moderate), but rather to a burn to the respiratory tract. The latter is dangerous because in the acute period acute respiratory failure may develop due to prolonged, intractable laryngobronchospasm, and in the next day severe pneumonia develops. The patient is bothered by a dry cough, sore throat, and suffocation. Objectively, shortness of breath (as during an attack of bronchial asthma), dry wheezing in the lungs, cyanosis of the lips, face, and anxiety are noted. Whenever toxic edema lungs, pneumonia, the condition of patients worsens even more, shortness of breath increases, breathing is frequent, up to 40-50 per minute, in the lungs there is an abundance of dry and moist wheezing of various sizes. Mortality in this group of patients is high. Treatment is mainly symptomatic: intravenous administration of bronchodilators (10 ml of 2.4% aminophylline solution with 10 ml of saline solution, 1 ml of 5% ephedrine solution, 60-90 mg of prednisolone 3-4 times or 250 mg of hydrocortisone 1 time per day, according to 1 ml of 5% ascorbic acid solution 3 times a day). Of great importance local therapy as oil inhalations(olive, apricot oil), inhalation of antibiotics (penicillin 500 thousand units in 10 ml of saline), vitamins (1 - 2 ml of 5% ascorbic acid solution with 10 ml of saline); with severe laryngobronchospasm - 10 ml of 2.4% aminophylline solution, 1 ml of 5% ephedrine solution, 125 mg of hydrocortisone in 10 ml of physiological solution. At severe cough use codeine with soda (1 tablet 3 times a day). The second severe complication of CO intoxication is positional injury (compartment syndrome), which develops in cases where the victim lies unconscious (or sits) in one position for a long time, touching parts of the body (most often with limbs) to a hard surface (corner of the bed, floor) or crushing the limb with the weight of his own body. In areas subject to compression, unfavorable conditions for blood and lymph circulation are created. In this case, the nutrition of muscle and nerve tissue, skin, which leads to their death. The victim develops areas of reddening of the skin, sometimes with the formation of blisters filled with liquid (like burns), hardening of soft tissues, which are further intensified due to developing edema. The affected areas become sharply painful, increased in volume, dense (up to stone density). As a result of the breakdown of muscle tissue, myoglobin (a protein that is part of muscle tissue) enters the blood; if the injury area is large, a large amount of myoglobin affects the kidneys: myoglobinuric nephrosis develops. Thus, the patient develops the so-called myorenal syndrome, characterized by a combination of positional trauma and renal failure. Treatment of patients with myorenal syndrome is long-term and is carried out in specialized hospitals, as it requires the use of various special methods(hemodialysis, lymphatic drainage, etc.). If there is severe pain, you can administer painkillers - 1 ml of a 2% solution of promedol and 2 ml of a 50% solution of analgin subcutaneously or intravenously.

Carbon monoxide analysis

To diagnose acute carbon monoxide poisoning, you should immediately determine the level of either carboxyhemoglobin (Hb CO) in the blood or carbon monoxide CO in the exhaled air.

Qualitative definition

The analysis uses whole blood treated with heparin or another stabilizer that prevents it from clotting. Approximately triple the volume of a 1% tannin solution is added to diluted samples (1:4) of test and normal blood. Normal blood turns gray, but blood containing carboxyhemoglobin remains unchanged. A similar test is carried out with the addition of formaldehyde. Wherein normal blood takes on a dirty brown color, and the blood being tested, containing carboxyhemoglobin, retains its color for several weeks. If the laboratory does not have these reagents, you can use a 30% sodium hydroxide solution, which is added to blood samples diluted 1:100 with water. Blood that does not contain carboxyhemoglobin acquires a green-black color. In the presence of carboxyhemoglobin, it remains pink color blood. Carboxyhemoglobin can be detected in the blood using a microdiffusion method based on the reaction with palladium chloride and spectrophotometrically.

quantitation

Quantitative determination of carboxyhemoglobin (HbCO) in the blood is based on the fact that both oxyhemoglobin (HbO2) and methemoglobin can be reduced by sodium dithionite, and HbCO does not interact with this reagent. For determination, an ammonia aqueous solution (1 ml/l) is required; solid sodium dithionite Na 2 S 2 O 4 2H 2 O (stored in a desiccator); a cylinder with pure gaseous CO or a mixture of CO and nitrogen; a cylinder containing oxygen gas or compressed air. It is possible to obtain CO by reacting concentrated sulfuric and formic acids. To determine, 0.2 ml of blood is added to 25 ml of ammonia solution and mixed thoroughly. The sample is divided into 3 approximately equal portions A, B and C. Portion A is stored in a sealed test tube. A portion of blood B is saturated with carbon monoxide until oxygen is completely replaced by CO (i.e., to obtain 100% Hb CO), blowing the gas through the solution for 5 - 10 minutes. Portion C is saturated with oxygen by blowing pure oxygen or compressed air through the solution for 10 minutes to completely replace CO with oxygen (0% Hb CO). To each solution (A, B, C) add a small amount (about 20 mg) of Na 2 S 2 O 4 2H 2 O and 10 ml of ammonia solution and mix. Take a spectrum in the visible region or measure absorption at 540 and 579 nm. A solution of sodium dithionite in an aqueous ammonia solution is used as a reference solution. The percentage of carboxyhemoglobin saturation can be calculated using the following formula: HbCO (%) = ( (A 540 / A 579 solution A) - (A 540 / A 579 solution C) * 100%) / ( (A 540 / A 579 solution B) - (A 540 / A 579 solution C) ), taking into account that (A 540 / A 579 solution B) = 1.5, which corresponds to 100% HbCO, (A 540 / A 579 solution C) = 1.1, which corresponds to 0% HCO. Measurements are carried out in the region of maximum difference between the absorption of Hb CO [λ max (Hb*CO) = 540 nm] and the point of equal absorption of Hb CO and Hb O 2 (579 nm, isosbestic point). The presence in the spectrum of solution A of two almost symmetrical peaks (“rabbit ears”) - characteristic feature carbon monoxide poisoning. Conclusion

More than 140 substances can be found in the combustion products of polymers, that is, poisoning of people occurs through the combined influence of many volatile poisons. The multifactorial influence during fires complicates the forensic chemical examination of the blood of the dead. In most cases, blood testing is limited to detecting carbon monoxide. In the vast majority of cases, poisoning occurs due to the fault of the victims themselves: improper operation of heating stoves, gas water heaters, smoking in bed (especially when drunk), leading to a fire; storing matches in places accessible to children; a long stay in a closed garage, where there is a car with a running engine, a long rest (sleep) in a car with the heater and engine on, even if the car is in the open air. It is especially important to conduct conversations and lectures with the population on the prevention of carbon monoxide poisoning in the autumn-winter season. In conclusion, it should be said that, despite significant progress in studying the problems of the mechanism of action of poisons, not all toxic substances have a fully disclosed biochemical mechanism of action. Many complex issues of the interaction of various chemical agents with different enzymes have not yet been resolved.